go back

South Dakota rates for HCPCS 28103

Excision or curettage of bone cyst or benign tumor, talus or calcaneus; with allograft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $3,548.13 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $389.05 / $812.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $912.01 / $1,148.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $660.69 / $1,047.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $676.08 / $3,981.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $933.25 / $933.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $891.25
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $660.69 / $758.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,370.32 / $5,370.32 / $5,370.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $707.95 / $1,122.02
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $891.25 / $933.25