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Utah rates for HCPCS 25924

Disarticulation Thru Wrist Re-Amputation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$897.31 / $3,038.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$664.30 / $897.31 / $3,665.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$639.19 / $960.66 / $1,514.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.47 / $421.15 / $668.82
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,147.96 / $12,655.20 / $18,168.36
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$944.28 / $1,128.63 / $1,600.49
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
$582.61 / $723.24 / $1,185.31