go back

South Dakota rates for HCPCS 25455

Epiphyseal arrest by epiphysiodesis or stapling; distal radius AND ulna

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$731.11 / $731.11 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.15 / $731.11 / $1,760.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,253.20 / $1,662.60 / $2,078.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$956.21 / $1,235.58 / $1,642.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$726.17 / $1,479.14 / $5,633.52
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,089.00 / $1,672.84 / $3,711.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,086.39 / $1,420.14 / $1,967.13
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.34 / $1,083.25 / $1,452.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $6,489.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$726.17 / $1,285.35 / $1,999.45
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,441.40 / $1,763.60 / $1,763.60