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Utah rates for HCPCS 21125

Agmntj Mndblr Body/Angle Prosthetic Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,118.59 / $4,179.16 / $9,932.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.07 / $2,525.17 / $5,503.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.01 / $2,590.54 / $4,687.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.57 / $1,504.41 / $2,317.36
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,413.68 / $11,103.62 / $16,181.16
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.73 / $2,865.44 / $7,048.97
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$871.00 / $4,912.00 / $11,831.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,453.36 / $3,069.63 / $4,772.51