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Utah rates for HCPCS 20805

Replantation Forearm Complete Amputation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,038.00 / $4,076.82 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,982.30 / $4,076.82 / $17,016.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,186.63 / $4,432.06 / $7,408.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$293.53 / $1,857.33 / $3,003.53
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25,703.20 / $32,053.62 / $46,017.58
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,245.76 / $5,077.28 / $8,290.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,680.00 / $4,912.00 / $24,613.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,746.61 / $3,409.57 / $5,428.12