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Utah rates for HCPCS 25622

Closed Tx Carpal Scaphoid Fracture W/O Manj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$367.20 / $403.57 / $4,387.00
Aetna
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$275.39 / $302.68 / $803.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.40 / $330.37 / $657.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.51 / $388.80 / $591.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.46 / $176.63 / $301.88
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$340.97 / $447.13 / $651.60
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.15 / $484.85 / $691.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.00 / $1,556.00 / $4,495.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.26 / $324.12 / $528.57