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Idaho rates for HCPCS 28455

Treatment of tarsal bone fracture (except talus and calcaneus); with manipulation, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,407.00 / $4,500.00 / $7,045.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.11 / $382.42 / $600.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$171.25 / $171.25 / $171.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.02 / $408.37 / $505.31
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$238.06 / $489.50 / $660.31
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$378.41 / $447.20 / $573.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $368.99 / $464.22
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,828.41 / $3,860.69 / $4,869.63
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.70 / $522.54 / $624.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.00 / $1,800.00 / $9,193.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$304.56 / $438.31 / $611.98