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South Dakota rates for HCPCS 25922

Disarticulation Thru Wrist Sec Closure/Scar Revj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$654.42 / $654.42 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$548.76 / $654.42 / $1,544.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,073.33 / $1,476.39 / $1,845.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$788.29 / $1,057.74 / $1,588.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.16 / $1,115.09 / $4,814.39
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,024.93 / $1,433.30 / $2,020.28
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$777.66 / $1,196.65 / $1,735.81
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$682.82 / $1,037.04 / $1,279.57
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
$570.80 / $1,115.09 / $1,734.60
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,269.40 / $1,553.10 / $1,553.10