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Pennsylvania rates for HCPCS 28555

Open treatment of tarsal bone dislocation, includes internal fixation, when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $3,890.45 / $8,511.38
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $10,000.00 / $57,543.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,122.02
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $2,691.53 / $8,317.64
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $741.31 / $1,778.28
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $549.54 / $724.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $5,495.41 / $22,387.21