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South Dakota rates for HCPCS 24900

Amputation, arm through humerus; with primary closure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $741.31 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $741.31 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,778.28 / $2,238.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $1,230.27 / $1,905.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,202.26 / $5,495.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,659.59 / $1,698.24
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,513.56 / $1,584.89
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,230.27 / $1,513.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,370.32 / $5,370.32 / $5,370.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,318.26 / $2,041.74
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,778.28 / $1,819.70