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South Dakota rates for HCPCS 50120

Pyelotomy; with exploration

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $954.99 / $1,380.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,187.76 / $2,691.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,380.38 / $2,454.71
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,698.24 / $7,079.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,089.30 / $2,238.72
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $1,949.84 / $1,949.84
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,621.81 / $1,862.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,819.70 / $2,630.27
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,137.96 / $2,238.72