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Utah rates for HCPCS L8658

Interphalangeal Joint Spacer Silicone Or Equal Each. (Rvsd 1/1/04)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.98 / $117.98 / $117.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.98 / $118.68 / $1,056.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$228.90 / $228.90 / $228.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.57 / $228.90 / $424.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $356.56 / $463.52
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.61 / $341.89 / $512.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.01 / $182.75 / $255.29