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South Dakota rates for HCPCS 27122

Acetabuloplasty; resection, femoral head (eg, Girdlestone procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,086.93 / $1,086.93 / $4,338.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,429.57 / $1,808.91 / $2,871.65
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,654.91 / $2,492.63 / $3,416.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,358.82 / $1,844.36 / $2,169.69
Sanford Health Plan
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$408.71 / $408.71 / $408.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,357.00 / $5,357.00 / $5,357.00