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Utah rates for HCPCS 15841

Graft for facial nerve paralysis; free muscle graft (including obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $6,025.60 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,778.28 / $2,691.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,238.72 / $2,951.21
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $6,456.54
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,888.44 / $6,918.31 / $13,803.84
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,454.71 / $6,309.57
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $2,238.72 / $3,388.44
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,511.89 / $3,548.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $5,128.61 / $8,317.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,819.70 / $2,630.27