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Louisiana rates for HCPCS 25905

Amputation, forearm, through radius and ulna; open, circular (guillotine)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $2,691.53 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $758.58 / $1,258.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $912.01 / $1,148.15
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $645.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $977.24 / $1,348.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $7,079.46 / $14,454.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $776.25 / $1,318.26