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South Dakota rates for HCPCS 55874

Transperineal Plmt Biodegradable Matrl 1/Mlt Njx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.32 / $2,817.12 / $5,442.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.28 / $432.54 / $4,708.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.29 / $469.00 / $8,135.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$196.60 / $2,639.25 / $5,357.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,197.05 / $7,931.85 / $20,949.68
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$405.92 / $6,145.22 / $9,259.67
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.35 / $5,274.96 / $7,987.84
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.81 / $2,949.88 / $5,291.00
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
$4,197.05 / $5,957.20 / $8,783.26
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.50 / $378.70 / $6,309.00