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South Dakota rates for HCPCS 25622

Closed Tx Carpal Scaphoid Fracture W/O Manj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$297.25 / $323.22 / $323.22
Aetna
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$222.94 / $222.94 / $242.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.53 / $296.94 / $498.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$542.61 / $746.38 / $932.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$391.35 / $487.24 / $749.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.70 / $691.12 / $2,370.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$230.01 / $657.20 / $814.20
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.00 / $633.74 / $814.20
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.93 / $500.71 / $633.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.72 / $489.30 / $851.98
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$579.50 / $709.00 / $768.70