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Utah rates for HCPCS 28555

Open treatment of tarsal bone dislocation, includes internal fixation, when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $3,388.44 / $4,897.79
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,471.29 / $12,302.69 / $28,183.83
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,174.90 / $1,862.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $5,128.61 / $15,848.93