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South Dakota rates for HCPCS 25490

Proph Tx N/P/Pltwr W/Wo Methylacrylate Radius

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$718.30 / $718.30 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$605.41 / $718.30 / $1,873.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,254.46 / $1,632.99 / $2,041.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$940.37 / $1,235.39 / $1,727.55
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$767.68 / $1,465.57 / $5,987.91
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,089.00 / $1,831.49 / $8,250.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,076.98 / $1,607.69 / $1,936.18
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$819.07 / $1,126.11 / $1,429.00
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
$767.68 / $1,268.06 / $1,972.54
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,417.60 / $1,734.50 / $1,734.50