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Utah rates for HCPCS 21256

Reconstruction Orbit W/Osteotomies & Bone Grafts

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,675.86 / $3,038.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,102.00 / $1,675.86 / $6,550.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,206.99 / $1,695.86 / $2,683.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.43 / $716.44 / $1,169.28
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
$1,620.50 / $1,970.80 / $2,965.38
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
$1,046.52 / $1,281.68 / $2,086.83