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South Dakota rates for HCPCS 25275

Repair, tendon sheath, extensor, forearm and/or wrist, with free graft (includes obtaining graft) (eg, for extensor carpi ulnaris subluxation)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $676.08 / $4,365.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,122.02 / $1,737.80
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,513.56 / $1,513.56
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,122.02 / $1,348.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28