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Utah rates for HCPCS 21401

Closed Tx Fx Orbit Except Blowout W/Manipulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$422.98 / $3,294.00 / $7,568.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.36 / $487.29 / $1,715.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.92 / $535.38 / $937.71
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.53 / $319.84 / $491.44
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,237.82 / $2,891.57 / $4,213.85
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.02 / $717.34 / $1,196.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,689.00 / $2,312.00 / $4,640.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.48 / $514.66 / $858.84