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Utah rates for HCPCS 20805

Replantation, forearm (includes radius and ulna to radial carpal joint), complete amputation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $4,073.80 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $4,073.80 / $17,378.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.30 / $4,365.16 / $7,079.46
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $2,454.71
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
$4,168.69 / $6,309.57 / $8,709.64
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $6,025.60 / $7,943.28
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,890.45 / $5,248.07 / $7,413.10
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
$2,691.53 / $3,311.31 / $5,370.32