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South Dakota rates for HCPCS 59120

Surgical treatment of ectopic pregnancy; tubal or ovarian, requiring salpingectomy and/or oophorectomy, abdominal or vaginal approach

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$692.97 / $692.97 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$692.97 / $787.80 / $973.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,723.82 / $1,728.82 / $2,161.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$926.08 / $1,171.11 / $2,057.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$902.26 / $1,568.32 / $5,890.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,170.76 / $1,951.27 / $2,537.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.00 / $1,766.92 / $2,211.02
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$987.68 / $1,357.15 / $1,596.55
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
$827.07 / $1,503.76 / $2,150.79
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,555.90 / $1,830.50 / $1,903.70