go back

Utah rates for HCPCS 21263

Periorbital osteotomies for orbital hypertelorism, with bone grafts; with forehead advancement

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,691.53 / $12,302.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,691.53 / $4,786.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $3,801.89
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
$2,884.03 / $3,890.45 / $5,370.32
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $3,801.89 / $5,495.41
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,754.23 / $3,548.13 / $5,248.07
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
$1,737.80 / $2,238.72 / $3,548.13