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South Dakota rates for HCPCS 27057

Decompression fasciotomy(ies), pelvic (buttock) compartment(s) (eg, gluteus medius-minimus, gluteus maximus, iliopsoas, and/or tensor fascia lata muscle) with debridement of nonviable muscle, unilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$993.09 / $993.09 / $3,073.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$835.52 / $993.09 / $2,910.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,726.07 / $2,246.92 / $2,808.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,200.22 / $1,569.17 / $2,650.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$979.23 / $2,053.48 / $7,421.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,515.43 / $2,284.29 / $3,125.38
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,321.44 / $2,147.41 / $2,715.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,253.66 / $1,699.41 / $1,982.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$979.23 / $1,780.54 / $2,769.73
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,967.00 / $2,406.60 / $2,406.60