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Utah rates for HCPCS 21151

Reconstruction midface, LeFort II; any direction, requiring bone grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.23 / $6,025.60 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,290.87 / $9,772.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,630.27 / $3,890.45
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $3,981.07
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
$2,344.23 / $3,388.44 / $5,248.07
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $3,311.31 / $4,365.16
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,754.23 / $4,265.80
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
$1,548.82 / $1,995.26 / $3,019.95