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Utah rates for HCPCS E0300

Pediatric crib, hospital grade, fully enclosed, with or without top enclosure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,096.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,584.89 / $2,454.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $1,949.84 / $1,949.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $1,949.84 / $3,630.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $186.21 / $229.09
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.30 / $3,235.94 / $3,311.31
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $323.59 / $1,862.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $870.96 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,258.93 / $2,398.83