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Utah rates for HCPCS 21172

Reconstruction superior-lateral orbital rim and lower forehead, advancement or alteration, with or without grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $6,025.60 / $9,332.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,511.89 / $10,964.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,511.89 / $4,570.88
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 / $10,000.00 / $22,387.21
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,754.23 / $3,630.78 / $4,897.79
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $3,467.37 / $5,011.87
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $3,162.28 / $4,897.79
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
$1,584.89 / $2,137.96 / $3,311.31