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South Dakota rates for HCPCS 25109

Excision of tendon, forearm and/or wrist, flexor or extensor, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$542.40 / $542.40 / $542.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$656.71 / $837.87 / $1,399.53
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$929.91 / $1,419.01 / $3,711.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.89 / $907.27 / $1,073.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00