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Utah rates for HCPCS 21450

Closed treatment of mandibular fracture; without manipulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $4,570.88 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $660.69 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $676.08 / $1,122.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,258.93
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $870.96 / $1,949.84
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $933.25 / $1,445.44
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $912.01 / $1,096.48
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $794.33 / $1,148.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $562.34 / $851.14