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Utah rates for HCPCS 21142

Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, without bone graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $5,248.07 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,659.59 / $7,585.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,862.09 / $3,235.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $3,801.89
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $9,772.37 / $22,387.21
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,691.53 / $3,715.35
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $2,884.03 / $4,265.80
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $2,137.96 / $3,162.28
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
$1,148.15 / $1,412.54 / $2,238.72