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South Dakota rates for HCPCS 50520

Closure Nephrocutaneous/Pyelocutaneous Fistula

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,063.67 / $1,063.67 / $2,290.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.87 / $1,063.67 / $3,340.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,429.82 / $2,493.90 / $3,117.37
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,365.46 / $1,643.00 / $2,773.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,228.93 / $2,150.63 / $8,389.36
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,605.71 / $2,780.95 / $3,614.47
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,848.00 / $2,429.82 / $3,115.37
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,346.90 / $1,816.37 / $2,269.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,643.00 / $1,643.00 / $1,643.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,228.93 / $2,048.21 / $3,117.97
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,251.30 / $2,648.50 / $2,754.50