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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
$196.19 / $2,516.00 / $8,294.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.80 / $196.19 / $264.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,735.00 / $2,390.00 / $2,954.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.78 / $213.40 / $352.81
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.25 / $215.75 / $794.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.42 / $302.42 / $302.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.44 / $244.87 / $425.01
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.93 / $248.23 / $292.66
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.37 / $240.79 / $357.54
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.00 / $275.00 / $387.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175.81 / $229.49 / $805.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.69 / $249.72 / $805.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$231.00 / $1,045.00 / $2,364.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.08 / $240.53 / $386.41