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Louisiana 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
$348.16 / $1,230.00 / $3,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.37 / $348.16 / $466.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$326.11 / $1,308.22 / $3,020.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.56 / $331.25 / $489.37
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $215.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.00 / $90.00 / $90.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.10 / $357.63 / $492.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.00 / $543.00 / $1,560.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.83 / $317.63 / $579.41