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South Dakota rates for HCPCS 25101

Arthrt Wrst W/Jt Expl W/Wo Bx W/Wo Rmvl Loose/Fb

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$412.26 / $412.26 / $3,511.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$536.15 / $699.37 / $1,046.89
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$760.94 / $1,075.26 / $3,711.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$495.56 / $681.33 / $817.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00