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Utah rates for HCPCS 20802

Replantation, arm (includes surgical neck of humerus through elbow joint), complete amputation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $3,235.94 / $14,454.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $3,311.31 / $6,456.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $5,128.61
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25,703.96 / $30,199.52 / $67,608.30
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,548.13 / $5,370.32 / $7,585.78
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $4,570.88 / $6,606.93
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,311.31 / $4,365.16 / $6,606.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $5,128.61 / $24,547.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,754.23 / $4,365.16