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South Dakota rates for HCPCS 28805

Amputation, foot; transmetatarsal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$700.49 / $700.49 / $3,511.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$849.47 / $1,103.38 / $1,952.90
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,123.88 / $1,634.02 / $2,184.73
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.00 / $1,207.43 / $1,376.60
Sanford Health Plan
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$269.33 / $269.33 / $269.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00