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Utah rates for HCPCS 21387

Open Tx Orbital Floor Blowout Fx Combined Appr

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,062.51 / $4,387.00 / $9,078.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$705.66 / $1,062.51 / $4,123.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$725.10 / $1,049.49 / $1,654.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.47 / $456.62 / $713.14
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
$1,001.72 / $1,200.81 / $1,781.72
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
$651.34 / $788.55 / $1,261.71