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South Dakota rates for HCPCS 25391

Osteoplasty, radius OR ulna; lengthening with autograft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$985.63 / $985.63 / $985.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$829.85 / $985.63 / $2,348.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,717.10 / $2,235.23 / $2,794.05
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,294.82 / $1,695.49 / $2,598.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,061.60 / $2,026.71 / $7,522.99
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,493.54 / $2,610.12 / $22,242.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,493.54 / $2,196.00 / $2,681.12
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,232.24 / $1,671.70 / $1,966.58
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
$883.17 / $1,753.63 / $2,727.87
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,950.90 / $2,387.00 / $2,387.00