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South Dakota rates for HCPCS 22630

Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace, lumbar;

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,468.87 / $1,468.87 / $4,338.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,929.96 / $2,445.85 / $4,034.91
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.76 / $3,436.63 / $4,897.16
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,950.80 / $2,663.12 / $3,088.30
Sanford Health Plan
Facility/Professional
Professional
Modifier
80
Low / Median / High Price
$589.39 / $589.39 / $589.39
Sanford Health Plan
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$589.39 / $589.39 / $589.39
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,571.00 / $6,571.00 / $6,571.00