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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
$777.75 / $777.75 / $777.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.22 / $664.12 / $1,204.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,328.07 / $1,728.82 / $2,161.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,293.91 / $1,814.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$710.43 / $1,443.02 / $5,622.08
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,285.00 / $1,862.59 / $3,711.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,048.93 / $1,505.00 / $2,047.28
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$779.74 / $1,186.29 / $1,480.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$755.87 / $1,443.02 / $2,015.94
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,469.00 / $1,797.30 / $1,797.30