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South Dakota rates for HCPCS 50130

Pyelotomy With Removal Calculus

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$974.60 / $974.60 / $974.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$878.23 / $974.60 / $2,968.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,251.80 / $2,306.14 / $2,882.67
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,255.86 / $1,647.07 / $2,765.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.56 / $2,050.94 / $7,669.52
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,607.38 / $2,548.14 / $3,144.16
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,704.00 / $2,251.80 / $2,729.85
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,291.79 / $1,720.87 / $2,001.51
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
$1,230.56 / $2,148.13 / $2,876.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,985.60 / $2,336.00 / $2,429.40