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Montana rates for HCPCS 28490

Closed treatment of fracture great toe, phalanx or phalanges; without manipulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $263.03 / $263.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $173.78 / $288.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $204.17 / $229.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $204.17 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $181.97 / $229.09
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $239.88 / $263.03
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $239.88 / $263.03
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $177.83 / $257.04
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $194.98 / $295.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $213.80 / $269.15