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Pennsylvania rates for HCPCS 25630

Closed treatment of carpal bone fracture (excluding carpal scaphoid [navicular]); without manipulation, each bone

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$428.00 / $2,070.00 / $7,175.00
Aetna
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$214.57 / $225.39 / $242.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.73 / $301.30 / $543.26
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,083.51 / $1,395.00 / $12,759.45
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.48 / $328.43 / $550.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$495.31 / $495.31 / $495.31
Cigna
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$346.72 / $346.72 / $346.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.69 / $355.35 / $583.95
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$379.47 / $511.31 / $655.44
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.55 / $613.87 / $1,286.68
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.20 / $320.39 / $352.44
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$617.00 / $2,326.00 / $8,017.00
Martin's Point
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$225.39 / $225.39 / $242.75
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.73 / $348.25 / $812.61
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$322.50 / $378.90 / $649.70
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$495.31 / $495.31 / $495.31
Priority Health
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$346.72 / $346.72 / $346.72
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.63 / $360.14 / $594.66
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$227.72 / $283.63 / $304.81
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.12 / $297.89 / $326.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.00 / $650.00 / $3,742.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.02 / $368.56 / $617.92