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
HC CL TRT GREAT TOE FX W/O MN
Hanover, PA
See all hospitals reporting CPT 28490 →Price type
UPMC Hanover’s median price of $275 is 12% below the median hospital's median price ($313), higher than 40% of the 1,941 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, 19 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 | Amerihealth Caritas community healthchoices (chc)/medicaid facility · fee schedule · outpatient | $70 | $70 | — | — | — | $70 – $70 |
| 2 | UnitedHealthcare pa medicaid facility · fee schedule · outpatient | $72 | $72 | — | — | — | $72 – $72 |
| 3 | Blue Cross Blue Shield medicare advantage facility · percent of total billed charges · outpatientfrom % of charges | $117 | $117 | — | — | — | $117 – $117 |
| 4 | Highmark medicare facility · fee schedule · outpatient | $227 | $227 | — | — | — | $227 – $227 |
| 5 | Humana medicare facility · fee schedule · outpatient | $229 | $229 | — | — | — | $229 – $229 |
| 6 | Aetna medicare facility · fee schedule · outpatient | $239 | $239 | — | — | — | $239 – $239 |
| 7 | Cigna medicare facility · fee schedule · outpatient | $241 | $241 | — | — | — | $241 – $241 |
| 8 | UnitedHealthcare medicare facility · fee schedule · outpatient | $245 | $245 | — | — | — | $245 – $245 |
| 9 | Aetna aco facility · percent of total billed charges · outpatientfrom % of charges | $351 | $351 | — | — | — | $351 – $351 |
| 10 | Highmark medicaid facility · fee schedule · outpatient | $415 | $415 | $345 | 83% | — | $70 – $760 |
| 11 | Blue Cross Blue Shield chip facility · percent of total billed charges · outpatientfrom % of charges | $420 | $420 | — | — | — | $420 – $420 |
| 12 | Blue Cross Blue Shield commercial facility · percent of total billed charges · outpatientfrom % of charges | $420 | $420 | — | — | — | $420 – $420 |
| 13 | Aetna commercial facility · percent of total billed charges · outpatientfrom % of charges | $450 | $450 | — | — | — | $450 – $450 |
| 14 | Cigna commercial facility · percent of total billed charges · outpatientfrom % of charges | $482 | $482 | — | — | — | $482 – $482 |
| 15 | Carefirst commercial facility · percent of total billed charges · inpatientfrom % of charges | $525 | $525 | — | — | — | $525 – $525 |
| 16 | Carefirst commercial facility · percent of total billed charges · outpatientfrom % of charges | $525 | $525 | — | — | — | $525 – $525 |
| 17 | MultiPlan ppo (includes phcs and humana as payers) facility · percent of total billed charges · inpatientfrom % of charges | $525 | $525 | — | — | — | $525 – $525 |
| 18 | MultiPlan ppo (includes phcs and humana as payers) facility · percent of total billed charges · outpatientfrom % of charges | $525 | $525 | — | — | — | $525 – $525 |
| 19 | Highmark commercial facility · fee schedule · outpatient | $815 | $815 | — | — | — | $815 – $815 |
Last updated: Mar 6, 2026
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