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Utah rates for HCPCS 21423

Open treatment of palatal or maxillary fracture (LeFort I type); complicated (comminuted or involving cranial nerve foramina), multiple approaches

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $6,025.60 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $912.01 / $4,365.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,096.48 / $1,737.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,737.80
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $9,772.37 / $21,379.62
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,513.56 / $2,089.30
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,445.44 / $1,819.70
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,288.25 / $1,862.09
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
$676.08 / $831.76 / $1,288.25