go back

Utah rates for HCPCS L8041

Midfacial prosthesis, provided by a nonphysician

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,778.28 / $16,218.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $2,884.03 / $2,884.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $2,454.71 / $2,951.21
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $2,454.71 / $3,162.28
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $2,951.21 / $5,128.61
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,398.83 / $3,630.78
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.03 / $3,388.44 / $3,630.78
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $3,467.37 / $4,365.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $1,348.96 / $2,290.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,621.81 / $2,290.87