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Utah rates for HCPCS 21263

Periorbital Osteotomies W/Bone Grafts W/Forehead

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,670.49 / $3,038.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,067.85 / $2,670.49 / $12,003.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,011.73 / $2,754.39 / $4,831.67
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.06 / $1,236.37 / $2,053.97
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
$2,920.73 / $3,509.85 / $4,694.21
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
$1,780.16 / $2,301.94 / $3,617.33