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Utah rates for HCPCS 28490

Cltx Fx Grt Toe Phlx/Phlg W/O Manj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.31 / $2,833.00 / $4,387.00
Aetna
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$123.98 / $123.98 / $142.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.43 / $165.31 / $604.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.97 / $176.76 / $268.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.98 / $90.56 / $127.13
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$340.97 / $447.13 / $651.60
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.40 / $213.47 / $319.89
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
$124.50 / $153.79 / $236.05