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South Dakota rates for HCPCS 28515

Cltx Fx Phlx/Phlg Oth/Thn Grt Toe W/Manj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.97 / $171.38 / $171.38
Aetna
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$111.73 / $111.73 / $128.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.94 / $147.46 / $304.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.73 / $397.34 / $496.68
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.24 / $251.76 / $400.92
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.19 / $376.26 / $1,264.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$230.01 / $329.21 / $428.14
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.65 / $330.81 / $428.14
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.42 / $270.95 / $331.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.69 / $325.38 / $460.40
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$287.50 / $351.80 / $402.00