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Virginia rates for HCPCS 28540

Closed treatment of tarsal bone dislocation, other than talotarsal; without anesthesia

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $2,630.27 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $199.53 / $389.05
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $2,570.40 / $2,951.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $257.04 / $446.68
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $275.42 / $933.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $239.88 / $416.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $245.47 / $295.12
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $288.40 / $446.68
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $239.88 / $380.19
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $138.04 / $138.04
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $229.09 / $1,288.25
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $251.19 / $1,288.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $1,148.15 / $2,398.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $218.78 / $380.19