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South Dakota rates for HCPCS 28304

Osteotomy, tarsal bones, other than calcaneus or talus;

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $851.14 / $4,365.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $1,202.26 / $1,905.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,380.38 / $1,905.46
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,230.27 / $1,621.81
Sanford Health Plan
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$316.23 / $316.23 / $316.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,370.32 / $5,370.32 / $5,370.32