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South Carolina 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
$162.18 / $4,365.16 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $147.91 / $269.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $371.54 / $676.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $144.54 / $199.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $165.96 / $213.80
Cigna
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$151.36 / $151.36 / $151.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $173.78 / $309.03
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $194.98 / $331.13
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $169.82 / $309.03
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 / $1,202.26 / $3,548.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $138.04 / $223.87