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Virginia rates for HCPCS 28103

Excision or curettage of bone cyst or benign tumor, talus or calcaneus; with allograft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$671.78 / $5,087.00 / $8,294.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.51 / $394.28 / $610.55
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,823.00 / $12,004.00 / $15,528.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.06 / $459.42 / $759.55
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.17 / $432.37 / $7,889.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$443.04 / $443.04 / $640.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$379.48 / $541.11 / $858.22
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.98 / $479.97 / $554.97
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$396.57 / $542.51 / $808.95
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.00 / $578.36 / $771.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$386.94 / $536.22 / $1,842.57
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.94 / $538.54 / $1,842.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,408.00 / $13,024.00 / $26,537.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$322.02 / $501.92 / $746.97