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Pennsylvania 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
$724.44 / $2,691.53 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $194.98 / $389.05
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,258.93 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $208.93 / $346.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $302.00 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $223.87 / $371.54
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $323.59 / $407.38
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $239.88 / $389.05
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $2,398.83 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $251.19 / $562.34
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $234.42 / $407.38
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $302.00 / $436.52
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.51 / $186.21 / $213.80
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $186.21 / $213.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $676.08 / $3,890.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $213.80 / $346.74