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South Dakota rates for HCPCS 25491

Proph Tx N/P/Pltwr W/Wo Methylmethacrylate Ulna

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$737.07 / $737.07 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$621.37 / $737.07 / $1,936.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,287.36 / $1,675.84 / $2,094.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$965.74 / $1,269.02 / $1,927.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$789.46 / $1,507.15 / $6,188.07
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,108.26 / $1,958.44 / $19,757.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,108.26 / $1,652.83 / $1,989.89
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$914.75 / $1,248.82 / $1,469.11
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
$789.46 / $1,303.27 / $2,027.31
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,457.40 / $1,783.20 / $1,783.20