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Virginia rates for HCPCS 28805

Amputation, foot; transmetatarsal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$819.91 / $5,087.00 / $8,294.00
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
$640.00 / $640.00 / $806.35
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$78.93 / $78.93 / $78.93
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$673.39 / $861.94 / $996.62
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$717.85 / $957.61 / $1,342.23
Medcost
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,264.50 / $1,444.01 / $2,859.62
Medcost
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$118.02 / $134.77 / $266.89
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$673.39 / $921.39 / $3,155.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,651.00 / $6,870.00 / $12,739.00