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South Dakota rates for HCPCS 25425

Repair of defect with autograft; radius OR ulna

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.52 / $954.52 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$803.72 / $954.52 / $2,702.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,662.63 / $2,164.34 / $2,705.42
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,253.42 / $1,660.00 / $2,510.67
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,026.97 / $1,960.58 / $8,630.24
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,444.34 / $2,557.09 / $13,091.73
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,444.34 / $2,140.44 / $2,594.60
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,190.63 / $1,617.26 / $1,902.53
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
$1,026.97 / $1,867.22 / $2,638.92
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,887.40 / $2,309.30 / $2,309.30