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South Dakota rates for HCPCS 23802

Arthrodesis, glenohumeral joint; with autogenous graft (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $4,365.16 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,258.93 / $2,398.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,951.21 / $3,715.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $2,089.30 / $3,388.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $2,137.96 / $9,549.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $2,884.03 / $2,884.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,818.38
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,137.96 / $2,511.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,370.32 / $5,370.32 / $5,370.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,290.87 / $3,548.13
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,951.21 / $3,090.30