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Washington rates for HCPCS 28555

Open Treatment Tarsal Bone Dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,137.84 / $2,110.82 / $17,100.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,129.64 / $18,873.74 / $38,781.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$625.25 / $761.81 / $11,926.94
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$801.64 / $1,451.00 / $8,035.82
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,074.14 / $1,648.20 / $1,744.01
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,156.06 / $1,189.57 / $8,653.58
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,146.66 / $20,262.22 / $38,781.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,028.00 / $5,547.00 / $19,271.00