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South Dakota rates for HCPCS 52317

Litholapaxy Smpl/Sm <2.5 Cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$322.97 / $885.67 / $10,267.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.82 / $885.67 / $1,544.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$761.96 / $967.69 / $2,460.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$439.71 / $1,110.83 / $2,203.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$966.94 / $2,277.02 / $7,358.63
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$847.34 / $1,936.42 / $2,896.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$783.83 / $1,631.29 / $2,119.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$565.29 / $1,224.56 / $1,642.48
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
$1,052.77 / $1,692.14 / $2,473.44
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.70 / $807.20 / $1,993.60