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Utah rates for HCPCS 21083

Impression and custom preparation; palatal lift prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $1,659.59 / $2,089.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,548.82 / $6,165.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,737.80 / $2,884.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $2,454.71
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,570.88 / $5,370.32 / $12,022.64
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,290.87 / $3,715.35
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $2,041.74 / $2,754.23
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,949.84 / $3,019.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,412.54 / $2,187.76