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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
$74.13 / $74.13 / $74.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $138.04 / $1,096.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $169.82 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $123.03 / $177.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $190.55 / $245.47
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $229.09 / $398.11
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $186.21 / $269.15
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $263.03 / $269.15
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $269.15 / $309.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $114.82 / $131.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $114.82 / $165.96