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Virginia rates for HCPCS 28615

Open treatment of tarsometatarsal joint dislocation, includes internal fixation, when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$910.89 / $5,087.00 / $8,294.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,823.00 / $12,004.00 / $15,528.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.00 / $640.00 / $939.63
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$93.73 / $93.73 / $93.73
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$797.12 / $1,020.31 / $1,203.60
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$779.50 / $1,019.47 / $1,525.20
Medcost
Facility/Professional
Facility
Modifier
80
Low / Median / High Price
$178.90 / $228.20 / $420.37
Medcost
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$125.23 / $159.74 / $294.26
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$718.03 / $1,010.59 / $3,542.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,408.00 / $13,296.00 / $26,537.00