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Utah 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
$190.55 / $3,019.95 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $186.21 / $501.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $169.82 / $281.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $213.80
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $398.11 / $870.96
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $234.42 / $323.59
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $234.42 / $281.84
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $213.80 / $288.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $141.25 / $213.80