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South Dakota rates for HCPCS 28555

Open treatment of tarsal bone dislocation, includes internal fixation, when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$665.93 / $881.11 / $881.11
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$878.64 / $1,175.50 / $2,012.37
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,338.57 / $1,852.25 / $11,833.19
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$880.39 / $1,283.45 / $1,646.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,357.00 / $5,357.00 / $5,357.00