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South Dakota rates for HCPCS 57180

Introduction of any hemostatic agent or pack for spontaneous or traumatic nonobstetrical vaginal hemorrhage (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.07 / $172.70 / $195.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.91 / $339.88 / $562.90
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.19 / $390.15 / $1,474.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.13 / $280.32 / $453.11
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.40 / $235.96 / $380.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.19 / $312.19 / $485.63
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.10 / $281.50 / $453.60