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South Dakota rates for HCPCS 25274

Repair, tendon or muscle, extensor, forearm and/or wrist; secondary, with free graft (includes obtaining graft), each tendon or muscle

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$670.98 / $670.98 / $670.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$563.90 / $670.98 / $1,859.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.26 / $1,528.59 / $1,910.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$877.92 / $1,148.02 / $1,745.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$712.11 / $1,359.48 / $5,932.82
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,235.60 / $1,765.47 / $3,711.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$998.89 / $1,493.44 / $1,791.37
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$816.97 / $1,128.39 / $1,327.44
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
$712.11 / $1,294.74 / $1,836.35
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,316.90 / $1,611.20 / $1,611.20