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Utah rates for HCPCS 25622

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $3,388.44 / $4,570.88
Aetna
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$794.33 / $794.33 / $794.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $389.05 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $380.19 / $660.69
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $524.81
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $398.11 / $870.96
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $537.03 / $707.95
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $524.81 / $660.69
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $467.74 / $645.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $309.03 / $478.63