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South Dakota rates for HCPCS 50930

Closure of ureterovisceral fistula (including visceral repair)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,038.72 / $1,038.72 / $1,038.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$935.49 / $1,038.72 / $3,167.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.10 / $2,454.94 / $3,068.68
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,337.75 / $1,755.44 / $2,951.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,315.39 / $2,192.32 / $8,172.88
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,718.61 / $2,715.46 / $3,350.63
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,921.00 / $2,398.10 / $2,910.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,379.15 / $1,836.33 / $2,131.54
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
$1,315.39 / $2,179.66 / $3,067.65
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,114.60 / $2,487.69 / $2,587.19