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South Dakota rates for HCPCS 25690

Closed treatment of lunate dislocation, with manipulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.78 / $501.78 / $2,290.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$424.12 / $501.78 / $1,196.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$882.19 / $1,148.39 / $1,435.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$609.25 / $806.97 / $1,246.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$473.01 / $970.03 / $3,716.08
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$709.32 / $1,231.52 / $1,969.98
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$709.32 / $995.01 / $1,324.18
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.40 / $814.06 / $992.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.11 / $862.65 / $1,341.90
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$984.40 / $1,204.50 / $1,204.50