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South Dakota rates for HCPCS 28455

Treatment of tarsal bone fracture (except talus and calcaneus); with manipulation, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $302.00 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $269.15 / $467.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $630.96 / $776.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $457.09 / $724.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $602.56 / $1,949.84
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $602.56 / $660.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $562.34 / $645.65
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $446.68 / $562.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $478.63 / $812.83
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $562.34 / $616.60