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South Dakota rates for HCPCS 50120

Pyelotomy W/Exploration

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$896.75 / $896.75 / $896.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$808.65 / $896.75 / $2,727.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,072.77 / $2,123.05 / $2,653.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,156.36 / $1,515.51 / $2,540.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,141.03 / $1,901.72 / $7,127.82
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,488.80 / $2,345.23 / $2,891.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,600.00 / $2,072.77 / $2,508.87
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,187.56 / $1,581.05 / $1,842.37
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,141.03 / $1,883.40 / $2,643.98
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,827.70 / $2,150.19 / $2,236.19