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Maryland rates for HCPCS 25905

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $724.44 / $1,995.26
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $831.76 / $1,023.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $512.86 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $912.01 / $1,584.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $776.25 / $1,380.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $1,000.00 / $3,548.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $851.14 / $1,412.54
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $831.76 / $1,071.52