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West Virginia rates for HCPCS 28103

Excision or curettage of bone cyst or benign tumor, talus or calcaneus; with allograft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$377.44 / $585.84 / $1,700.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.51 / $394.28 / $587.71
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$414.61 / $453.70 / $494.30
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.43 / $439.38 / $439.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$443.04 / $443.04 / $443.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$376.90 / $580.04 / $1,107.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.39 / $497.17 / $879.83