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Utah rates for HCPCS 25695

Open treatment of lunate dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $4,168.69 / $21,877.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $812.83 / $3,548.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $870.96 / $1,380.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,348.96
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
$831.76 / $1,230.27 / $1,584.89
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $1,174.90 / $1,513.56
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,047.13 / $1,513.56
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
$549.54 / $660.69 / $1,023.29