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South Dakota rates for HCPCS 25449

Revision of arthroplasty, including removal of implant, wrist joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $4,365.16 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,023.29 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,398.83 / $2,951.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,737.80 / $2,691.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,698.24 / $7,585.78
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,344.23 / $2,344.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,137.96 / $2,290.87
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,737.80 / $2,041.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $4,466.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,862.09 / $2,818.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,398.83 / $2,454.71