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South Dakota rates for HCPCS 20936

Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.57 / $122.57 / $2,290.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.57 / $118.14 / $168.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.68 / $270.35 / $337.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.74 / $199.66 / $333.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.73 / $260.93 / $1,634.59
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.36 / $279.08 / $384.82
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.00 / $250.71 / $323.67
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$877.92 / $877.92 / $877.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.73 / $221.69 / $344.85
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.80 / $270.10 / $270.10