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Maine rates for HCPCS 28540

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $208.93 / $512.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $263.03 / $389.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $269.15 / $416.87
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $275.42 / $524.81
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $257.04 / $602.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $245.47 / $426.58