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South Dakota rates for HCPCS 20802

Replantation Arm Complete Amputation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,671.33 / $2,671.33 / $2,671.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,248.21 / $2,671.33 / $6,507.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,637.18 / $6,036.47 / $7,545.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,229.57 / $4,426.75 / $7,165.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,503.61 / $5,657.25 / $20,642.09
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,183.93 / $6,161.84 / $8,455.28
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,183.93 / $5,165.05 / $7,340.46
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,383.65 / $4,630.00 / $5,354.39
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,571.00 / $6,571.00 / $6,571.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,963.32 / $4,820.09 / $7,497.92
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,311.80 / $6,499.10 / $6,499.10