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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
$758.58 / $3,630.78 / $4,365.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,288.25 / $2,041.74
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,737.80 / $1,737.80
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,288.25 / $1,513.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53