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South Dakota rates for HCPCS 25312

Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single; with tendon graft(s) (includes obtaining graft), each tendon

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $724.44 / $4,365.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $1,230.27 / $1,995.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,621.81 / $1,621.81
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,202.26 / $1,412.54
Sanford Health Plan
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$275.42 / $275.42 / $275.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $4,466.84