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South Dakota rates for HCPCS 52204

Cystourethroscopy, with biopsy(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.22 / $379.38 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.99 / $379.38 / $724.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.98 / $599.82 / $1,031.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$171.81 / $402.64 / $948.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.64 / $1,042.68 / $3,502.01
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.30 / $867.63 / $1,679.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.41 / $700.83 / $984.69
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.51 / $518.47 / $686.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.58 / $752.96 / $1,089.36
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.20 / $330.60 / $833.10