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South Dakota rates for HCPCS 28615

Open Treatment Tarsometatarsal Joint Dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$834.66 / $834.66 / $3,511.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,011.84 / $1,288.47 / $2,071.69
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,220.25 / $2,052.44 / $10,541.18
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$909.52 / $1,339.66 / $1,634.07
Sanford Health Plan
Facility/Professional
Professional
Modifier
80
Low / Median / High Price
$299.70 / $299.70 / $299.70
Sanford Health Plan
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$299.70 / $299.70 / $299.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,357.00 / $5,357.00 / $5,357.00