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Utah rates for HCPCS 26121

Fasciectomy, palm only, with or without Z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $6,025.60 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $741.31 / $2,691.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $812.83 / $1,318.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,047.13
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,677.35 / $5,495.41 / $12,589.25
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,148.15 / $1,479.11
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $1,096.48 / $1,445.44
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $977.24 / $1,412.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $5,128.61 / $8,317.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $630.96 / $1,000.00