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Texas rates for HCPCS 28805

Amputation Foot Transmetarsal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$789.00 / $3,174.00 / $10,893.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,395.59 / $4,243.05 / $8,384.57
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,061.44 / $4,023.13 / $8,000.00
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$637.77 / $3,559.06 / $3,559.06
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $7,768.60
Lucent Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$162.00 / $736.98 / $736.98
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$663.39 / $858.01 / $1,394.27
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$668.53 / $860.04 / $1,442.77
Providence
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$78.93 / $78.93 / $228.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,154.00 / $3,326.00 / $7,600.00