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South Dakota rates for HCPCS 28630

Closed treatment of metatarsophalangeal joint dislocation; without anesthesia

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $151.36 / $245.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $323.59 / $457.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $316.23 / $1,174.90
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $251.19 / $363.08
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $245.47 / $354.81
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $234.42 / $309.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $234.42 / $416.87
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $269.15 / $371.54