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South Dakota rates for HCPCS 25900

Amputation Forearm Through Radius & Ulna

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$717.00 / $717.00 / $717.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$605.07 / $717.00 / $1,732.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,261.64 / $1,642.34 / $2,052.92
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$938.24 / $1,231.30 / $1,836.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.40 / $1,447.85 / $5,488.46
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,064.06 / $1,611.53 / $2,223.31
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,064.06 / $1,560.00 / $1,927.98
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$868.84 / $1,194.55 / $1,431.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,357.00 / $5,357.00 / $5,357.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.40 / $1,378.90 / $1,954.76
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,420.20 / $1,737.60 / $1,737.60