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Michigan rates for HCPCS 25622

Closed Tx Carpal Scaphoid Fracture W/O Manj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.75 / $396.05 / $4,933.00
Aetna
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$275.06 / $285.64 / $308.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.53 / $317.64 / $484.11
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$256.77 / $274.89 / $392.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.37 / $217.21 / $309.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.27 / $372.34 / $574.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.49 / $327.22 / $613.34
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.08 / $366.75 / $4,933.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$275.06 / $275.06 / $297.04
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.22 / $366.75 / $522.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.81 / $195.22 / $360.97
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.00 / $1,418.00 / $2,029.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$293.35 / $354.08 / $486.34