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South Dakota rates for HCPCS 28455

Tx Tarsal Bone Fx Xcp Talus&Calcn W/Manj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$270.58 / $305.08 / $305.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.11 / $270.58 / $616.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.06 / $610.80 / $763.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.39 / $457.30 / $683.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.55 / $666.39 / $1,970.27
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$335.23 / $574.97 / $732.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.44 / $597.03 / $733.23
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.83 / $434.42 / $511.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.69 / $521.62 / $811.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$455.00 / $556.70 / $620.29