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South Dakota rates for HCPCS 57291

Construction of artificial vagina; without graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $4,365.16 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $512.86 / $758.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,258.93 / $1,584.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $812.83 / $1,380.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $954.99 / $5,011.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,202.26 / $1,230.27
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,096.48
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $912.01 / $1,071.52
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
$562.34 / $1,023.29 / $1,479.11
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,230.27 / $1,288.25