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South Dakota rates for HCPCS 58740

Lysis Of Adhesions Salpinx/Ovary

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$811.04 / $811.04 / $4,338.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,080.32 / $1,370.66 / $2,316.94
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,336.19 / $2,212.48 / $2,798.96
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,031.08 / $1,501.23 / $1,766.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00