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South Dakota rates for HCPCS 25450

Epiphyseal arrest by epiphysiodesis or stapling; distal radius OR ulna

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$620.57 / $620.57 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$523.29 / $620.57 / $1,547.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,080.57 / $1,414.07 / $1,767.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$800.00 / $1,050.09 / $1,392.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$583.86 / $1,089.56 / $4,946.76
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,080.57 / $1,422.80 / $3,711.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$791.39 / $1,220.93 / $1,666.59
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$633.69 / $919.75 / $1,233.64
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
$560.21 / $1,018.56 / $1,694.87
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,223.80 / $1,497.40 / $1,497.40