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South Dakota rates for HCPCS 25685

Open treatment of trans-scaphoperilunar type of fracture dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $3,548.13 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $741.31 / $1,445.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,698.24 / $2,137.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $1,230.27 / $1,905.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,202.26 / $5,495.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,659.59 / $1,659.59
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,513.56 / $1,584.89
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,230.27 / $1,445.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,318.26 / $1,995.26
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,698.24 / $1,778.28