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South Dakota rates for HCPCS 58750

Tubotubal anastomosis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$820.16 / $820.16 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$763.82 / $820.16 / $2,511.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,991.97 / $2,006.96 / $2,508.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,092.26 / $1,386.07 / $2,403.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,103.23 / $1,838.72 / $7,322.65
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,433.21 / $2,240.15 / $2,830.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,481.00 / $1,991.97 / $2,451.21
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,102.80 / $1,505.08 / $1,770.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,103.23 / $1,825.48 / $2,506.59
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,725.50 / $2,030.00 / $2,111.19