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Utah rates for HCPCS 25275

Repair, tendon sheath, extensor, forearm and/or wrist, with free graft (includes obtaining graft) (eg, for extensor carpi ulnaris subluxation)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$944.60 / $4,312.00 / $8,344.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,684.92 / $6,137.22 / $8,943.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $6,097.00 / $8,267.00