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Arizona rates for HCPCS 28540

Closed treatment of tarsal bone dislocation, other than talotarsal; without anesthesia

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,170.00 / $2,640.00 / $5,506.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.93 / $183.55 / $386.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.71 / $337.73 / $552.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.50 / $240.60 / $285.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.15 / $223.44 / $367.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.97 / $227.13 / $1,126.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.84 / $226.32 / $1,511.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$716.00 / $1,535.00 / $2,175.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.60 / $196.98 / $376.64