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South Dakota rates for HCPCS 54690

Laparoscopy Surgical Orchiectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$590.22 / $590.22 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$548.26 / $590.22 / $1,891.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,435.95 / $1,473.28 / $1,841.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$784.01 / $997.47 / $1,825.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$786.01 / $1,310.02 / $4,888.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,142.00 / $1,717.89 / $5,090.60
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,176.00 / $1,435.95 / $1,736.63
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$821.26 / $1,094.26 / $1,276.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,357.00 / $5,357.00 / $5,357.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$786.01 / $1,176.17 / $1,829.60
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,243.90 / $1,463.40 / $1,521.90