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South Dakota rates for HCPCS 25250

Removal of wrist prosthesis; (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$538.22 / $538.22 / $2,290.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$454.07 / $538.22 / $1,291.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$943.24 / $1,227.85 / $1,534.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$652.27 / $909.59 / $1,377.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$506.58 / $1,082.63 / $3,995.68
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$793.48 / $1,324.49 / $1,969.98
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$793.48 / $1,105.31 / $1,441.66
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$653.88 / $899.01 / $1,068.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$567.09 / $942.85 / $1,464.18
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,060.20 / $1,297.20 / $1,297.20