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South Dakota rates for HCPCS 23802

Arthrodesis Glenohumeral Jt W/Autogenous Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,265.34 / $1,265.34 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,066.31 / $1,265.34 / $3,064.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,206.07 / $2,871.76 / $3,589.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,538.24 / $2,008.62 / $3,357.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,188.60 / $2,610.98 / $9,454.64
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,932.00 / $3,135.04 / $15,588.16
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,924.40 / $2,675.24 / $3,443.40
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,583.17 / $2,153.12 / $2,527.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,357.00 / $5,357.00 / $5,357.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,367.66 / $2,579.78 / $3,508.82
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,507.30 / $3,067.80 / $3,067.80