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South Dakota rates for HCPCS 50125

Pyelotomy; with drainage, pyelostomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$927.79 / $927.79 / $927.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$836.72 / $927.79 / $2,822.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,143.35 / $2,196.28 / $2,745.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,196.51 / $1,567.97 / $2,629.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,214.72 / $2,024.54 / $7,304.24
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,582.25 / $2,426.69 / $2,995.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,673.00 / $2,143.35 / $2,595.34
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,229.51 / $1,636.74 / $1,905.12
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
$1,214.72 / $1,948.66 / $2,735.80
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,890.00 / $2,223.50 / $2,312.40