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Utah rates for HCPCS 21267

Orbital repositioning, periorbital osteotomies, unilateral, with bone grafts; extracranial approach

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $6,025.60 / $10,232.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,137.96 / $8,709.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $2,137.96 / $3,467.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $2,951.21
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
$2,089.30 / $3,162.28 / $4,168.69
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $2,884.03 / $3,890.45
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,570.40 / $3,715.35
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
$1,348.96 / $1,659.59 / $2,570.40