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South Dakota rates for HCPCS 58291

Vag Hyst > 250 Gm Rmvl Tube&/Ovary

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,117.13 / $1,117.13 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,097.81 / $1,372.83 / $4,709.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,717.60 / $2,730.75 / $3,413.43
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,487.21 / $1,887.95 / $3,280.67
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,451.39 / $2,420.26 / $9,209.36
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,894.95 / $3,057.25 / $3,862.64
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,015.00 / $2,717.60 / $3,350.77
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,509.62 / $2,053.33 / $2,415.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,330.44 / $2,418.98 / $3,446.60
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,354.10 / $2,769.50 / $2,880.30