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South Dakota rates for HCPCS 57295

Revision (including removal) of prosthetic vaginal graft; vaginal approach

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $4,365.16 / $8,317.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $776.25 / $1,258.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,096.48 / $1,122.02
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $831.76 / $977.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53