Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
PR CLTX FX GRT TOE PHLX/PHLG W/O MANJ
Boulder, CO
See all hospitals reporting CPT 28490 →Price type
Boulder Community Health’s median price of $245 is 22% below the median hospital's median price ($313), higher than 27% of the 1,959 hospitals reporting CPT 28490. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 9 payers, 28 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Aetna medicare advantage professional · case rate · both | $137 | $137 | — | — | — | $137 – $137 |
| 2 | Anthem medicare advantage professional · fee schedule · both | $137 | $137 | — | — | — | $137 – $137 |
| 3 | Devoted medicare advantage professional · fee schedule · both | $137 | $137 | — | — | — | $137 – $137 |
| 4 | Humana medicare advantage professional · fee schedule · both | $137 | $137 | — | — | — | $137 – $137 |
| 5 | Kaiser medicare advantage professional · fee schedule · both | $170 | $170 | — | — | — | $170 – $170 |
| 6 | Anthem commercial professional · fee schedule · both | $161 | $177 | $25 | 14% | — | $161 – $217 |
| 7 | UnitedHealthcare medicare advantage professional · fee schedule · both | $200 | $200 | $63 | 31% | — | $137 – $263 |
| 8 | MultiPlan commercial professional · fee schedule · both | $206 | $206 | — | — | — | $206 – $206 |
| 9 | Phcs commercial professional · fee schedule · both | $206 | $206 | — | — | — | $206 – $206 |
| 10 | Cigna commercial facility · fee schedule · outpatient | $212 | $212 | — | — | — | $212 – $212 |
| 11 | Anthem managed care professional · fee schedule · both | $217 | $217 | — | — | — | $217 – $217 |
| 12 | Kaiser commercial professional · fee schedule · both | $217 | $217 | — | — | — | $217 – $217 |
| 13 | Cigna commercial professional · percent of total billed charges · bothfrom % of charges | $220 | $220 | — | — | — | $220 – $220 |
| 14 | Cigna commercial professional · fee schedule · both | $222 | $222 | — | — | — | $222 – $222 |
| 15 | Aetna commercial professional · fee schedule · both | $245 | $245 | — | — | — | $245 – $245 |
| 16 | Aetna ppo professional · fee schedule · both | $245 | $245 | — | — | — | $245 – $245 |
| 17 | UnitedHealthcare commercial professional · fee schedule · both | $246 | $246 | — | — | — | $246 – $246 |
| 18 | Aetna medicare advantage facility · case rate · outpatient | $263 | $263 | — | — | — | $263 – $263 |
| 19 | Anthem medicare advantage facility · case rate · outpatient | $263 | $263 | — | — | — | $263 – $263 |
| 20 | Humana medicare advantage facility · case rate · outpatient | $268 | $268 | — | — | — | $268 – $268 |
| 21 | UnitedHealthcare medicare advantage facility · case rate · outpatient | $268 | $268 | — | — | — | $268 – $268 |
| 22 | Kaiser medicare advantage facility · case rate · outpatient | $270 | $270 | $1 | 0% | — | $268 – $271 |
| 23 | Devoted medicare advantage facility · case rate · outpatient | $271 | $271 | — | — | — | $271 – $271 |
| 24 | Kaiser commercial facility · case rate · outpatient | $574 | $574 | $69 | 12% | — | $505 – $644 |
| 25 | Kaiser managed care facility · case rate · outpatient | $637 | $637 | — | — | — | $637 – $637 |
Last updated: Sep 16, 2026
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