go back

South Dakota rates for HCPCS 28264

Capsulotomy Midtarsal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$674.17 / $887.93 / $887.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$957.32 / $1,305.33 / $2,028.86
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,343.81 / $1,823.10 / $2,394.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,010.42 / $1,355.26 / $1,744.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00