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Virginia rates for HCPCS 28630

Closed treatment of metatarsophalangeal joint dislocation; without anesthesia

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.68 / $150.60 / $221.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.36 / $132.44 / $218.96
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.07 / $131.91 / $1,757.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.92 / $168.40 / $301.93
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.88 / $192.40 / $227.38
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.00 / $214.11 / $290.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.05 / $194.87 / $749.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.34 / $178.69 / $295.89