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Utah rates for HCPCS L0861

Addition To Halo Procedure Replacement Liner/Interface Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.72 / $74.72 / $74.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.72 / $86.56 / $731.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.00 / $168.00 / $168.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.64 / $122.64 / $304.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.82 / $191.66 / $249.15
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.89 / $256.39 / $256.39
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.99 / $183.78 / $275.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.62 / $114.70 / $135.93