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Utah rates for HCPCS 84375

Sugars, chromatographic, TLC or paper chromatography

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $10.96 / $77.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $28.84 / $40.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.11 / $34.67 / $107.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $38.02 / $56.23
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.11 / $70.79 / $186.21
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $33.11 / $34.67
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $38.90 / $123.03
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $34.67 / $38.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.50 / $19.50 / $60.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.48 / $16.22 / $26.92