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South Dakota rates for HCPCS G0289

Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.40 / $80.40 / $80.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.24 / $135.88 / $174.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.19 / $133.99 / $190.76
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.92 / $144.12 / $164.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00