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South Dakota rates for HCPCS 25924

Disarticulation Thru Wrist Re-Amputation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$719.12 / $719.12 / $719.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.89 / $719.12 / $1,703.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,246.08 / $1,622.09 / $2,027.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$920.97 / $1,170.66 / $1,768.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$669.17 / $1,375.06 / $5,300.32
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,009.32 / $1,539.76 / $2,231.65
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,009.32 / $1,371.62 / $1,917.05
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$821.71 / $1,154.43 / $1,410.24
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
$640.22 / $1,233.63 / $1,918.98
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,399.00 / $1,711.70 / $1,711.70