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South Dakota rates for HCPCS 50290

Excision Perinephric Cyst

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$850.42 / $850.42 / $850.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$766.83 / $850.42 / $2,582.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,963.60 / $2,013.19 / $2,516.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.57 / $1,437.21 / $2,402.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,070.94 / $1,784.90 / $6,690.08
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,397.66 / $2,222.55 / $2,740.57
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,504.00 / $1,963.60 / $2,379.16
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,123.99 / $1,495.18 / $1,745.34
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
$1,070.94 / $1,784.90 / $2,503.12
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,731.40 / $2,037.00 / $2,118.50