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Utah rates for HCPCS 21261

Periorbital osteotomies for orbital hypertelorism, with bone grafts; combined intra- and extracranial approach

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $3,162.28 / $13,182.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $3,019.95 / $5,248.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $4,073.80
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
$3,162.28 / $4,168.69 / $5,754.40
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $4,365.16 / $5,888.44
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $3,801.89 / $5,623.41
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
$1,905.46 / $2,398.83 / $3,801.89