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South Dakota rates for HCPCS 25085

Capsulotomy Wrist

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$455.06 / $455.06 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.29 / $455.06 / $874.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$799.60 / $1,040.88 / $1,301.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$593.34 / $769.05 / $1,169.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.96 / $919.53 / $4,139.31
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$839.70 / $1,135.94 / $3,711.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$673.48 / $985.21 / $1,211.25
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.54 / $763.92 / $899.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.96 / $810.06 / $1,240.82
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$892.70 / $1,092.20 / $1,092.20