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Pennsylvania rates for HCPCS 28264

Capsulotomy Midtarsal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$715.18 / $2,070.00 / $7,629.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,639.91 / $11,851.00 / $26,582.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,174.90
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$715.18 / $2,326.00 / $8,017.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,174.90
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.22 / $810.38 / $887.55
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,332.00 / $3,879.00 / $7,508.00