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Wisconsin 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
$177.83 / $380.19 / $1,905.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $194.98 / $457.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $3,090.30 / $5,754.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $346.74 / $870.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $630.96 / $1,000.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $645.65 / $954.99
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $281.84 / $3,162.28
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $457.09 / $602.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $316.23 / $1,584.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $398.11 / $1,513.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $245.47
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $467.74 / $691.83
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $478.63 / $1,288.25
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $954.99 / $1,479.11
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $575.44 / $645.65
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $1,174.90 / $1,318.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,548.82 / $1,949.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $281.84 / $758.58