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Utah rates for HCPCS 25624

Closed treatment of carpal scaphoid (navicular) fracture; with manipulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $3,388.44 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $562.34 / $2,570.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $602.56 / $1,071.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $977.24
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $2,691.53 / $6,025.60
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $831.76 / $1,122.02
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $831.76 / $1,047.13
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $758.58 / $1,122.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $2,818.38 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $478.63 / $741.31