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West Virginia rates for HCPCS 28555

Open Treatment Tarsal Bone Dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$915.80 / $989.38 / $1,194.98
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $766.20 / $834.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,109.33 / $1,109.33 / $1,109.33
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,331.97 / $1,331.97 / $8,079.09