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South Carolina 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
$338.84 / $4,897.79 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $295.12 / $512.86
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $371.54 / $676.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $288.40 / $467.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $234.42 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $363.08 / $602.56
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $436.52 / $676.08
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $354.81 / $630.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $1,230.27 / $4,677.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $281.84 / $467.74