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South Dakota rates for HCPCS 25116

Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, Tbc, or other granulomas, rheumatoid arthritis); extensors, with or without transposition of dorsal retinaculum

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$611.77 / $611.77 / $611.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$797.57 / $1,051.40 / $1,558.26
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,128.11 / $1,583.01 / $3,711.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.41 / $1,011.09 / $1,210.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00