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Pennsylvania rates for HCPCS 28555

Open Treatment Tarsal Bone Dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$680.06 / $2,467.00 / $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
$1,109.33 / $1,109.33 / $1,109.33
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,045.14 / $15,089.40 / $18,968.65
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$895.11 / $2,675.00 / $8,017.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,109.33 / $1,109.33 / $1,109.33
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$547.28 / $650.65 / $841.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,468.00 / $4,563.00 / $9,631.00