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Utah rates for HCPCS 25685

Open treatment of trans-scaphoperilunar type of fracture dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $5,888.44 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $1,000.00 / $4,073.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,000.00 / $1,621.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,548.82
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
$954.99 / $1,412.54 / $1,862.09
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,348.96 / $1,778.28
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,202.26 / $1,737.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $5,128.61 / $7,079.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $776.25 / $1,174.90