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Utah rates for HCPCS 25316

Flexor origin slide (eg, for cerebral palsy, Volkmann contracture), forearm and/or wrist; with tendon(s) transfer

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $5,888.44 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,258.93 / $5,011.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,258.93 / $2,137.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,621.81
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,471.29 / $12,302.69 / $28,183.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,778.28 / $2,454.71
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,698.24 / $2,187.76
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,479.11 / $2,238.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $5,128.61 / $15,848.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $977.24 / $1,548.82