go back

Utah rates for HCPCS 92004

Oph Svcs Medical Xm&Eval Compre New Pt 1/> Vst

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.83 / $112.83 / $161.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.90 / $127.51 / $231.20
Aetna
Facility/Professional
Professional
Modifier
25
Low / Median / High Price
$18.02 / $91.40 / $295.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.50 / $131.09 / $243.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.98 / $143.16 / $183.27
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.09 / $153.74 / $213.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.70 / $137.38 / $215.73