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South Dakota rates for HCPCS 25315

Flexor Origin Slide Forearm &/Wrist

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$766.42 / $766.42 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.74 / $766.42 / $2,052.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,337.05 / $1,740.51 / $2,175.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,004.80 / $1,338.34 / $2,010.01
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$822.36 / $1,569.96 / $6,555.30
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,155.00 / $2,040.53 / $8,250.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,155.00 / $1,716.86 / $2,073.69
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$953.42 / $1,297.21 / $1,526.04
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
$822.36 / $1,357.70 / $2,111.98
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.90 / $1,852.30 / $1,852.30