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South Dakota rates for HCPCS 25680

Closed treatment of trans-scaphoperilunar type of fracture dislocation, with manipulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $3,090.30 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $537.03 / $954.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,258.93 / $1,584.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $851.14 / $1,230.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $794.33 / $3,981.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,174.90 / $1,174.90
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $977.24 / $1,047.13
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $812.83 / $1,071.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $933.25 / $1,445.44
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,258.93 / $1,288.25