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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
$1,096.48 / $4,365.16 / $4,897.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,819.70 / $2,884.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,511.89 / $2,511.89
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,862.09 / $2,187.76
Sanford Health Plan
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$416.87 / $416.87 / $416.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,370.32 / $5,370.32 / $5,370.32