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Utah rates for HCPCS 21143

Rcnstj Midface Lefort I 3/> Piece W/O Bone Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,085.96 / $5,563.00 / $8,344.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,297.32 / $2,085.96 / $7,610.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,465.32 / $1,991.03 / $3,312.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.65 / $832.67 / $1,312.84
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,238.37 / $11,103.62 / $16,181.16
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,829.37 / $2,351.60 / $3,673.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $7,693.00 / $13,847.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,220.63 / $1,560.27 / $2,381.48