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South Carolina 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
$223.87 / $4,897.79 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $199.53 / $346.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $371.54 / $676.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $194.98 / $263.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $199.53 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $251.19 / $426.58
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $288.40 / $446.68
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $245.47 / $416.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $1,202.26 / $3,548.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $194.98 / $323.59