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South Dakota rates for HCPCS 58925

Ovarian cystectomy, unilateral or bilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$690.88 / $690.88 / $4,338.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$920.18 / $1,167.58 / $1,956.81
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,127.93 / $1,882.36 / $2,387.07
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$917.32 / $1,276.86 / $1,502.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00