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South Dakota rates for HCPCS 25251

Removal of wrist prosthesis; complicated, including total wrist

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $2,290.87 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $724.44 / $1,479.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,659.59 / $2,089.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $1,202.26 / $1,862.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,174.90 / $5,370.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,621.81 / $1,621.81
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,479.11 / $1,584.89
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,202.26 / $1,445.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,288.25 / $1,995.26
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,659.59 / $1,737.80