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South Dakota rates for HCPCS 28450

Treatment of tarsal bone fracture (except talus and calcaneus); without manipulation, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$198.41 / $220.11 / $220.11
Aetna
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$148.81 / $148.81 / $165.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.38 / $199.28 / $339.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.86 / $508.69 / $635.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.01 / $335.31 / $513.12
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.90 / $487.47 / $1,621.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$230.01 / $438.12 / $559.16
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.00 / $438.12 / $559.16
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.22 / $358.56 / $428.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.89 / $430.70 / $595.50
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.00 / $471.10 / $519.79