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South Dakota rates for HCPCS 50130

Pyelotomy; with removal of calculus (pyelolithotomy, pelviolithotomy, including coagulum pyelolithotomy)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $977.24 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,047.13 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,344.23 / $2,951.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,621.81 / $2,691.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,862.09 / $7,585.78
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,238.72 / $2,398.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,137.96 / $2,137.96
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,737.80 / $1,995.26
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 / $1,949.84 / $2,884.03
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,344.23 / $2,454.71