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Utah rates for HCPCS 25455

Epiphyseal arrest by epiphysiodesis or stapling; distal radius AND ulna

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $5,888.44 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $870.96 / $4,073.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $870.96 / $1,584.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $562.34
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,677.35 / $5,495.41 / $12,589.25
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,258.93 / $1,659.59
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,348.96 / $1,737.80
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,122.02 / $1,621.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $758.58 / $1,174.90