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South Dakota rates for HCPCS 25650

Closed Treatment Ulnar Styloid Fracture

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.83 / $345.52 / $345.52
Aetna
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$239.13 / $239.13 / $259.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.04 / $295.94 / $534.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$535.91 / $745.80 / $988.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.71 / $523.39 / $798.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.60 / $731.88 / $2,532.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$230.01 / $705.24 / $860.72
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$509.00 / $681.66 / $860.72
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$341.79 / $532.85 / $674.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.17 / $562.20 / $906.50
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$621.90 / $760.90 / $819.00