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Pennsylvania rates for HCPCS 28805

Amputation Foot Transmetarsal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$845.05 / $2,747.00 / $7,763.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,296.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$806.35 / $806.35 / $806.35
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$78.93 / $78.93 / $78.93
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,937.35 / $10,409.61 / $17,247.77
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$749.00 / $3,623.00 / $8,017.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$806.35 / $806.35 / $806.35
Priority Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$78.93 / $78.93 / $78.93
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$649.12 / $691.98 / $691.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,747.00 / $2,824.00 / $5,678.00