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South Dakota rates for HCPCS 0071T

Focused ultrasound ablation of uterine leiomyomata, including MR guidance; total leiomyomata volume less than 200 cc of tissue

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $1,778.28 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,778.28 / $1,995.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,760.83 / $6,760.83 / $8,317.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $2,398.83 / $2,951.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $2,398.83 / $5,248.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $2,454.71 / $2,454.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $2,454.71 / $5,248.07