go back

South Dakota rates for HCPCS 50630

Urtrolithotomy Lower One-Third Ureter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$842.86 / $842.86 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$759.76 / $842.86 / $2,566.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,946.86 / $1,993.72 / $2,492.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,086.46 / $1,424.43 / $2,389.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,069.55 / $1,782.58 / $6,633.76
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,396.26 / $2,203.91 / $2,718.66
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,503.00 / $1,946.86 / $2,358.75
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,117.07 / $1,487.05 / $1,730.46
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
$1,069.55 / $1,597.68 / $2,485.28
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,716.70 / $2,019.60 / $2,100.40