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South Dakota rates for HCPCS 50290

Excision of perinephric cyst

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $851.14 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $912.01 / $1,288.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,041.74 / $2,570.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,445.44 / $2,290.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,621.81 / $6,760.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $1,949.84 / $2,089.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $1,862.09
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,513.56 / $1,737.80
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
$977.24 / $1,698.24 / $2,511.89
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,041.74 / $2,137.96