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Utah rates for HCPCS 21422

Open treatment of palatal or maxillary fracture (LeFort I type);

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $6,025.60 / $9,332.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $724.44 / $3,467.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $891.25 / $1,348.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,412.54
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $9,772.37 / $22,387.21
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,258.93 / $1,737.80
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $1,148.15 / $1,548.82
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,023.29 / $1,479.11
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
$549.54 / $691.83 / $1,071.52