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Utah rates for HCPCS 15841

Graft Facial Nerve Paralysis Free Muscle Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.92 / $4,387.00 / $8,344.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,294.15 / $1,655.78 / $2,689.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,609.06 / $2,177.48 / $3,303.46
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.68 / $1,029.61 / $1,647.61
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,537.58 / $6,904.89 / $9,912.95
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,935.10 / $2,184.89 / $2,920.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $6,097.00 / $8,267.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,395.86 / $1,827.11 / $2,630.07