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Pennsylvania rates for HCPCS 28304

Osteotomy, tarsal bones, other than calcaneus or talus;

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$858.26 / $2,543.00 / $8,427.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,393.00 / $11,479.00 / $18,724.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,051.54 / $1,051.54 / $1,051.54
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$105.15 / $105.15 / $105.15
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$942.90 / $942.90 / $71,355.67
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$858.27 / $2,679.00 / $8,247.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,051.54 / $1,051.54 / $1,051.54
Priority Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$105.15 / $105.15 / $105.15
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$601.58 / $639.58 / $803.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,468.00 / $4,563.00 / $9,631.00