go back

South Dakota rates for HCPCS 50580

Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.54 / $564.54 / $2,290.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$507.92 / $564.54 / $1,750.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,306.40 / $1,329.92 / $1,662.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$700.00 / $954.07 / $1,634.77
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.27 / $1,207.11 / $4,459.84
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,076.00 / $1,579.68 / $4,555.17
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,025.00 / $1,306.40 / $1,587.71
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$760.72 / $1,014.19 / $1,161.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.27 / $1,083.76 / $1,685.85
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,151.90 / $1,355.20 / $1,409.40