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South Dakota rates for HCPCS 25115

Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, Tbc, or other granulomas, rheumatoid arthritis); flexors

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$760.67 / $3,649.91 / $3,649.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$994.99 / $1,301.08 / $1,974.73
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,257.44 / $1,722.92 / $2,020.28
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$906.06 / $1,281.26 / $1,509.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00