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Utah rates for HCPCS 21260

Periorbital Osteotomies Bone Grafts Extracranial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,867.58 / $3,038.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,264.78 / $1,867.58 / $7,344.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,294.68 / $1,810.04 / $2,945.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.43 / $781.58 / $1,271.70
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
$1,783.68 / $2,282.19 / $3,019.11
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
$1,151.36 / $1,483.70 / $2,292.48