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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
$458.38 / $458.38 / $3,511.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$610.30 / $774.66 / $1,257.13
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$834.00 / $1,302.34 / $2,929.96
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$585.28 / $832.55 / $979.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00