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South Dakota rates for HCPCS 23155

Excision or curettage of bone cyst or benign tumor of proximal humerus; with autograft (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $4,365.16 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $794.33 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,862.09 / $2,290.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,348.96 / $2,089.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,318.26 / $5,888.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,778.28 / $1,778.28
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,659.59 / $1,737.80
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,348.96 / $1,584.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,412.54 / $2,187.76
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,862.09 / $1,905.46