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Utah rates for HCPCS 28455

Tx Tarsal Bone Fx Xcp Talus&Calcn W/Manj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.89 / $2,910.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.37 / $366.89 / $1,373.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.61 / $368.75 / $486.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.98 / $159.44 / $220.21
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,304.17 / $3,047.35 / $4,440.85
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.88 / $450.88 / $664.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.00 / $1,556.00 / $4,495.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.87 / $307.11 / $499.01