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Utah rates for HCPCS 21145

Reconstruction midface, LeFort I; single piece, segment movement in any direction, requiring bone grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $6,606.93 / $13,803.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,778.28 / $8,511.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $2,137.96 / $3,311.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $4,265.80
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $9,772.37 / $21,379.62
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,951.21 / $4,265.80
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $3,235.94 / $4,786.30
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,454.71 / $3,630.78
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
$1,288.25 / $1,621.81 / $2,511.89