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Utah rates for HCPCS A2004

Misc W/Motor Score 12-32

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.95 / $12.95 / $12.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.64 / $12.95 / $13.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.26 / $13.26 / $13.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.26 / $13.26 / $13.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $60.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.00 / $13.00 / $13.00