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Utah rates for HCPCS L8043

Upper facial prosthesis, provided by a nonphysician

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,304.88 / $1,304.88 / $1,304.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,304.88 / $1,516.85 / $13,508.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,600.52 / $3,600.52 / $3,600.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,060.44 / $3,600.52 / $3,708.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$777.00 / $1,629.21 / $3,801.21
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,744.33 / $4,175.91 / $4,175.91
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,377.91 / $2,993.29 / $4,489.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,825.01 / $2,021.25 / $2,892.48