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South Dakota rates for HCPCS 58954

Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking; with pelvic lymphadenectomy and limited para-aortic lymphadenectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,939.49 / $1,939.49 / $1,939.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,135.50 / $3,069.12 / $5,736.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,305.67 / $5,326.27 / $6,687.71
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,650.73 / $3,668.02 / $4,222.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00