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Utah rates for HCPCS 84704

Gonadotropin, chorionic (hCG); free beta chain

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $37.15 / $47.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $12.02 / $18.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.18 / $13.49 / $41.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.55 / $17.38 / $28.84
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.14 / $27.54 / $79.43
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.47 / $12.88 / $13.80
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.72 / $15.14 / $47.86
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.75 / $13.49 / $15.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $7.59 / $10.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.12 / $12.59 / $15.14