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South Dakota rates for HCPCS 25272

Repair, tendon or muscle, extensor, forearm and/or wrist; secondary, single, each tendon or muscle

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$563.72 / $563.72 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.22 / $563.72 / $1,590.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$986.33 / $1,283.96 / $1,604.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$735.95 / $968.96 / $1,440.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$594.52 / $1,134.99 / $5,317.68
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,039.15 / $1,483.50 / $3,711.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$832.60 / $1,258.35 / $1,511.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$626.15 / $940.30 / $1,118.49
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
$594.52 / $986.92 / $1,535.21
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,109.59 / $1,357.60 / $1,357.60