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South Dakota rates for HCPCS 25145

Sequestrectomy Forearm &/Wrist

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$526.29 / $526.29 / $3,073.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$443.96 / $526.29 / $1,476.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$922.29 / $1,200.58 / $1,500.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$686.17 / $905.27 / $1,342.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.44 / $1,056.57 / $4,922.89
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$953.00 / $1,376.49 / $3,711.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$774.02 / $1,168.63 / $1,406.14
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$637.15 / $876.00 / $1,044.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$458.92 / $835.76 / $1,429.34
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,035.80 / $1,267.30 / $1,267.30