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South Dakota rates for HCPCS 22633

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,713.86 / $2,433.19 / $17,080.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,081.57 / $2,839.52 / $4,801.46
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,729.26 / $4,087.68 / $5,724.10
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,323.86 / $3,124.10 / $3,561.83
Sanford Health Plan
Facility/Professional
Professional
Modifier
80
Low / Median / High Price
$692.99 / $692.99 / $692.99
Sanford Health Plan
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$692.99 / $692.99 / $692.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,150.00 / $7,150.00 / $7,150.00