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Utah rates for HCPCS 14021

Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq cm to 30.0 sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $5,888.44 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $794.33 / $1,698.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,023.29 / $1,348.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $2,630.27
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $3,311.31 / $7,244.36
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,148.15 / $1,949.84
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,318.26 / $2,089.30
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,122.02 / $1,949.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $812.83 / $1,230.27