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Utah rates for HCPCS 21155

Rcnstj Midface Lefort Iii W/Lefort I

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,064.99 / $4,387.00 / $8,344.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,984.73 / $3,064.99 / $11,334.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,383.80 / $3,125.22 / $4,684.21
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.88 / $1,214.54 / $1,973.03
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,238.37 / $10,273.82 / $14,749.55
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,815.42 / $3,583.67 / $5,862.58
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
$1,872.00 / $2,239.19 / $3,610.93