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Virginia rates for HCPCS 28104

Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus;

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$603.44 / $2,705.00 / $7,275.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,032.00 / $6,548.00 / $7,221.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$572.00 / $572.00 / $608.79
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$60.88 / $60.88 / $60.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$502.57 / $646.01 / $763.46
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$397.87 / $588.29 / $898.00
Medcost
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$83.90 / $124.32 / $181.19
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$349.02 / $453.72 / $1,703.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,651.00 / $6,556.00 / $12,739.00