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South Dakota rates for HCPCS 51050

Cystolithotomy Cystotomy W/Rmvl Calculus

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.07 / $450.07 / $450.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$572.54 / $760.62 / $1,257.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$797.00 / $1,237.72 / $4,555.17
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$590.75 / $786.36 / $925.07
Sanford Health Plan
Facility/Professional
Professional
Modifier
80
Low / Median / High Price
$175.79 / $175.79 / $175.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00