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South Dakota rates for HCPCS 24930

Amputation, arm through humerus; re-amputation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $776.25 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $776.25 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,778.28 / $2,238.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,288.25 / $2,041.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,258.93 / $5,754.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,737.80 / $1,737.80
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,621.81 / $1,659.59
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,318.26 / $1,548.82
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
$812.83 / $1,348.96 / $2,137.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,778.28 / $1,862.09