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South Dakota rates for HCPCS 25622

Closed treatment of carpal scaphoid (navicular) fracture; without manipulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $323.59 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $309.03 / $616.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $758.58 / $954.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $489.78 / $741.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $630.96 / $2,344.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $630.96 / $691.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $616.60 / $676.08
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $524.81 / $645.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $549.54 / $851.14
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $707.95 / $776.25