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Maine rates for HCPCS 28630

Closed treatment of metatarsophalangeal joint dislocation; without anesthesia

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $154.88 / $309.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $165.96 / $239.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $194.98 / $316.23
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $213.80 / $389.05
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $190.55 / $407.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $165.96 / $331.13