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Utah rates for HCPCS 25250

Removal Wrist Prosthesis Separate Procedure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$735.33 / $3,038.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$495.56 / $735.33 / $2,796.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.97 / $737.40 / $1,188.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.47 / $329.32 / $497.94
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,304.17 / $3,047.35 / $4,440.85
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$711.91 / $845.69 / $1,245.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,689.00 / $2,312.00 / $4,640.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.89 / $551.88 / $889.13