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California rates for HCPCS 25622

Closed treatment of carpal scaphoid (navicular) fracture; without manipulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$276.01 / $6,695.00 / $18,483.00
Aetna
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$186.40 / $207.01 / $1,443.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.43 / $280.93 / $764.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,723.00 / $4,464.00 / $8,976.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.01 / $376.79 / $740.90
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.00 / $100.00 / $1,581.82
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.18 / $295.97 / $645.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.00 / $253.20 / $453.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.14 / $362.96 / $779.96
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.37 / $367.90 / $496.67
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.01 / $412.33 / $727.79
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $1,391.08 / $1,550.40
Lucent Health
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$956.89 / $1,085.28 / $1,085.28
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,150.80 / $2,370.56 / $2,763.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.99 / $395.83 / $534.08
Providence
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$345.03 / $345.03 / $594.86
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.76 / $385.65 / $787.58
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$927.25 / $927.25 / $1,010.20
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.91 / $334.36 / $447.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$548.00 / $1,533.00 / $6,323.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.52 / $306.66 / $696.04