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Montana 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
$177.83 / $251.19 / $512.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $288.40 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $257.04 / $316.23
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $338.84 / $363.08
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $338.84 / $363.08
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $263.03 / $389.05
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $263.03 / $407.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $302.00 / $371.54