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South Dakota rates for HCPCS 57155

Insertion Uterine Tandem&/Vaginal Ovoids

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$261.13 / $372.46 / $372.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.46 / $346.38 / $383.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.00 / $847.43 / $1,165.73
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$349.06 / $585.38 / $949.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.05 / $761.33 / $4,954.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$662.15 / $868.62 / $3,737.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$629.54 / $757.83 / $1,022.01
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.24 / $585.99 / $752.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,643.00 / $1,643.00 / $1,643.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.57 / $708.08 / $1,074.64
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$545.29 / $667.20 / $937.20