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Utah rates for HCPCS 21275

Secondary revision of orbitocraniofacial reconstruction

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $6,025.60 / $10,232.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,096.48 / $4,570.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,148.15 / $1,819.70
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,949.84
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
$1,096.48 / $1,621.81 / $2,137.96
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,548.82 / $2,041.74
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,318.26 / $1,949.84
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
$707.95 / $870.96 / $1,348.96