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South Dakota rates for HCPCS 57426

Revision Prosthetic Vaginal Graft Laparoscopic

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$791.07 / $791.07 / $4,338.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,053.18 / $1,248.66 / $2,225.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,286.85 / $2,284.67 / $6,152.06
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.44 / $1,445.69 / $1,700.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00