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South Dakota rates for HCPCS 25375

Mlt Osteotomies W/Relignmt Imed Rod Radius&Ulna

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$945.04 / $945.04 / $945.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$795.77 / $945.04 / $2,284.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,646.47 / $2,143.30 / $2,679.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,240.81 / $1,632.02 / $2,484.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,015.93 / $1,939.50 / $7,050.08
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,428.65 / $2,189.94 / $3,711.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,428.65 / $1,964.52 / $2,568.21
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,178.18 / $1,602.41 / $1,885.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,015.93 / $1,893.45 / $2,612.90
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,870.10 / $2,288.10 / $2,288.10