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South Dakota rates for HCPCS 58673

Laparoscopy Salpingostomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$712.49 / $712.49 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.78 / $712.49 / $2,228.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,734.35 / $1,743.63 / $2,179.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$949.21 / $1,204.10 / $2,105.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$932.63 / $1,554.38 / $6,544.97
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,401.00 / $2,106.54 / $8,568.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,378.00 / $1,734.35 / $2,136.56
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$970.46 / $1,316.47 / $1,541.56
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
$1,022.13 / $1,540.01 / $2,198.84
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,502.40 / $1,767.50 / $1,838.20