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South Dakota rates for HCPCS 25105

Arthrotomy Wrist Joint With Synovectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$495.42 / $495.42 / $495.42
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.34 / $837.26 / $1,251.01
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$910.46 / $1,285.00 / $3,711.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$590.38 / $811.70 / $978.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00