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West Virginia rates for HCPCS 28455

Treatment of tarsal bone fracture (except talus and calcaneus); with manipulation, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$249.44 / $345.54 / $1,200.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.62 / $277.82 / $386.01
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.92 / $267.58 / $291.55
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.77 / $259.14 / $259.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.33 / $394.33 / $394.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.34 / $354.17 / $786.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.44 / $330.72 / $445.09