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Utah rates for HCPCS 21453

Closed treatment of mandibular fracture with interdental fixation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $4,570.88 / $8,511.38
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $10,000.00 / $22,387.21
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,513.56 / $2,238.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $5,128.61 / $13,803.84