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South Dakota rates for HCPCS 24931

Amputation Arm Thru Humerus W/Implant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$919.99 / $919.99 / $919.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$774.75 / $919.99 / $2,228.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,603.38 / $2,087.21 / $2,609.01
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,112.93 / $1,490.88 / $2,081.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$863.79 / $1,652.99 / $6,870.88
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,228.20 / $2,095.32 / $2,885.50
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,228.20 / $1,767.71 / $2,505.37
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$949.07 / $1,370.21 / $1,837.84
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
$865.85 / $1,639.78 / $2,550.77
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,823.20 / $2,230.80 / $2,230.80