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Utah rates for HCPCS 21183

Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra- and extracranial excision of benign tumor of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes obtaining grafts); total area of bone grafting greater than 40 sq cm but less than 80 sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $6,025.60 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,884.03 / $12,302.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $3,162.28 / $5,011.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $4,570.88
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
$2,951.21 / $4,466.84 / $6,165.95
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $4,168.69 / $5,623.41
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,754.23 / $3,715.35 / $5,370.32
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
$1,949.84 / $2,398.83 / $3,715.35