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South Dakota rates for HCPCS 26502

Reconstruction of tendon pulley, each tendon; with tendon or fascial graft (includes obtaining graft) (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $776.25 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $776.25 / $1,318.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,778.28 / $2,187.76
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,288.25 / $1,819.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,174.90 / $5,623.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,584.89 / $1,621.81
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $1,548.82
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,174.90 / $1,479.11
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
$758.58 / $1,288.25 / $1,995.26
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,737.80 / $1,778.28