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South Dakota rates for HCPCS 20802

Replantation, arm (includes surgical neck of humerus through elbow joint), complete amputation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,691.53 / $5,128.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,677.35 / $6,165.95 / $7,762.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $4,466.84 / $7,244.36
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $4,570.88 / $20,417.38
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $6,165.95 / $6,165.95
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $4,897.79 / $6,025.60
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $4,570.88 / $5,370.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $6,606.93 / $6,606.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $4,786.30 / $7,585.78
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,370.32 / $6,309.57 / $6,456.54