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South Dakota rates for HCPCS 28104

Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus;

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$357.12 / $536.73 / $3,634.42
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$513.22 / $762.22 / $1,235.79
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$814.58 / $1,152.83 / $3,711.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.71 / $705.12 / $1,024.69
Sanford Health Plan
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$198.31 / $198.31 / $198.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00