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Utah rates for HCPCS L8042

Orbital prosthesis, provided by a nonphysician

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,165.07 / $1,165.07 / $1,165.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,165.07 / $1,354.33 / $12,061.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,214.74 / $3,214.74 / $3,214.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,732.53 / $3,214.74 / $3,311.18
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$693.77 / $1,454.68 / $3,393.94
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,343.16 / $3,728.49 / $3,728.49
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,123.13 / $2,672.58 / $4,008.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,629.47 / $1,804.68 / $2,589.04