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Utah rates for HCPCS 25900

Amputation Forearm Through Radius & Ulna

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,027.01 / $3,038.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.63 / $1,027.01 / $3,731.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$705.98 / $1,019.52 / $1,569.06
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.47 / $420.05 / $701.17
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,947.45 / $24,875.82 / $35,712.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$949.93 / $1,164.88 / $1,658.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,028.00 / $9,753.00 / $15,824.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$617.66 / $759.24 / $1,208.30