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Utah rates for HCPCS 21175

Rcnstj Bifrontal Superior-Lat Orb Rims & Lwr Fhd

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,294.00 / $4,387.00 / $9,078.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,031.14 / $3,434.66 / $11,674.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,176.40 / $3,170.45 / $4,766.97
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.06 / $1,249.51 / $2,055.71
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,413.68 / $11,103.62 / $16,181.16
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,872.42 / $3,551.32 / $6,028.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.00 / $7,693.00 / $13,847.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,898.10 / $2,382.44 / $3,885.29