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South Dakota rates for HCPCS 25125

Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding head or neck of radius and olecranon process); with autograft (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $3,548.13 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $602.56 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,412.54 / $1,737.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,023.29 / $1,659.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $977.24 / $5,370.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,348.96 / $1,348.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $1,318.26
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $1,023.29 / $1,202.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,071.52 / $1,621.81
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,380.38 / $1,445.44