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South Dakota rates for HCPCS 50400

Pyeloplasty Simple

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,088.80 / $1,088.80 / $1,088.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$980.95 / $1,239.83 / $2,338.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,515.28 / $2,574.15 / $3,217.68
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,402.76 / $1,840.07 / $3,096.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,379.33 / $2,298.88 / $10,108.39
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,802.53 / $2,848.48 / $3,517.49
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,901.00 / $2,515.28 / $3,050.52
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,451.36 / $1,925.68 / $2,235.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,379.33 / $2,076.19 / $3,229.63
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,217.90 / $2,609.30 / $2,713.70