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South Dakota rates for HCPCS 52301

Cysto W/Resecj Ectopic Ureterocele Uni/Bi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$270.58 / $270.58 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.74 / $270.58 / $836.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$625.91 / $638.86 / $798.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$348.55 / $457.30 / $781.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.86 / $576.44 / $2,135.52
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$509.00 / $753.93 / $3,079.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$477.00 / $625.91 / $760.23
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.41 / $485.63 / $556.33
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
$317.04 / $576.44 / $804.19
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.90 / $649.29 / $675.30