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Utah 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
$275.42 / $3,162.28 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $245.47 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $251.19 / $416.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $346.74
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $398.11 / $870.96
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $331.13 / $457.09
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $331.13 / $398.11
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $288.40 / $398.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $199.53 / $302.00