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Utah rates for HCPCS 21440

Closed treatment of mandibular or maxillary alveolar ridge fracture (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $4,570.88 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $707.95 / $3,548.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $707.95 / $1,380.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,318.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,570.88 / $5,370.32 / $12,022.64
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,047.13 / $1,445.44
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,071.52 / $1,380.38
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,047.13 / $1,584.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $5,128.61 / $7,079.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $602.56 / $912.01