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South Dakota rates for HCPCS 58671

Laparoscopy W/Plmt Occlusion Device Oviducts

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$337.90 / $337.90 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.90 / $368.56 / $581.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$814.69 / $828.18 / $1,035.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.16 / $571.04 / $956.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.73 / $712.40 / $2,806.88
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$625.00 / $982.27 / $5,090.60
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.00 / $816.59 / $1,004.02
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.44 / $616.99 / $725.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,357.00 / $5,357.00 / $5,357.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.73 / $711.22 / $1,019.45
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.40 / $832.20 / $865.50