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Pennsylvania rates for HCPCS 28805

Amputation, foot; transmetatarsal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $4,365.16 / $8,317.64
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,417.38 / $21,379.62 / $57,543.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,202.26 / $1,202.26
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$120.23 / $120.23 / $120.23
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,762.47 / $10,471.29 / $17,378.01
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $3,801.89 / $8,317.64
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $831.76 / $1,412.54
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $691.83 / $1,096.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $3,548.13 / $10,000.00