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South Dakota rates for HCPCS 50520

Closure of nephrocutaneous or pyelocutaneous fistula

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $2,290.87 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,174.90 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $2,570.40 / $3,162.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $1,621.81 / $2,754.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,995.26 / $8,317.64
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,454.71 / $2,570.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,137.96 / $2,137.96
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,905.46 / $2,290.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $1,659.59 / $1,659.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $2,041.74 / $2,951.21
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,630.27 / $2,754.23