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Utah rates for HCPCS 99455

Work related or medical disability examination by the treating physician that includes: Completion of a medical history commensurate with the patient's condition; Performance of an examination commensurate with the patient's condition; Formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; Development of future medical treatment plan; and Completion of necessary documentation/certificates and report.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $83.18 / $125.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $40.74 / $40.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $44.67 / $54.95
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $54.95 / $72.44
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.51 / $43.65 / $48.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $128.82