go back

South Dakota rates for HCPCS G0276

Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar decompression (PILD) or placebo-control, performed in an approved coverage with evidence development (CED) clinical trial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$359.33 / $359.33 / $359.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.33 / $359.33 / $430.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.75 / $393.75 / $492.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$449.10 / $630.72 / $1,024.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.22 / $670.36 / $2,316.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$519.29 / $674.22 / $8,250.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.29 / $601.86 / $982.41
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.29 / $620.74 / $707.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,357.00 / $5,357.00 / $5,357.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.22 / $654.77 / $797.40
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.40 / $620.90 / $620.90