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South Dakota rates for HCPCS 28540

Closed treatment of tarsal bone dislocation, other than talotarsal; without anesthesia

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $204.17 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $194.98 / $354.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $478.63 / $602.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $309.03 / $489.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $407.38 / $1,513.56
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $407.38 / $457.09
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $398.11 / $436.52
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $331.13 / $398.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $354.81 / $549.54
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $426.58 / $478.63