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Utah rates for HCPCS 21422

Open Treatment Palatal/Maxillary Fracture

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$934.69 / $4,387.00 / $9,078.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$576.59 / $719.92 / $3,402.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$682.94 / $925.53 / $1,350.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.47 / $370.06 / $589.74
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,238.37 / $11,103.62 / $16,181.16
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$815.90 / $1,071.38 / $1,685.47
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
$553.49 / $700.56 / $1,088.54