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South Dakota rates for HCPCS 25695

Open treatment of lunate dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$635.52 / $635.52 / $3,073.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$535.73 / $635.52 / $1,529.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,110.22 / $1,445.23 / $1,806.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.53 / $1,074.03 / $1,648.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$607.59 / $1,290.68 / $4,729.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$953.00 / $1,567.79 / $8,250.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$948.19 / $1,314.25 / $1,713.96
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$782.09 / $1,074.50 / $1,264.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$561.37 / $1,119.40 / $1,741.29
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,254.00 / $1,534.30 / $1,534.30