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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
$933.25 / $933.25 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,000.00 / $1,445.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,238.72 / $2,818.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,445.44 / $2,511.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,778.28 / $7,244.36
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,137.96 / $2,290.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,041.74 / $2,041.74
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,659.59 / $1,905.46
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
$1,122.02 / $1,905.46 / $2,754.23
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,238.72 / $2,290.87