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South Carolina rates for HCPCS 50400

Pyeloplasty Simple

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,405.78 / $3,189.90 / $16,467.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,126.64 / $1,405.78 / $3,019.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,241.37 / $4,241.37 / $7,986.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,072.55 / $1,672.00 / $2,939.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,186.55 / $1,622.14 / $3,017.40
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,126.64 / $1,555.64 / $2,559.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.60 / $1,083.46 / $1,789.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $12,798.00 / $19,665.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,129.97 / $1,579.96 / $2,835.53