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South Dakota rates for HCPCS 53621

Dilat Urethral Strix Filiform & Follwr Male Sbsq

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.31 / $161.66 / $161.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.31 / $126.96 / $161.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.72 / $199.64 / $464.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.14 / $193.26 / $286.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.46 / $306.20 / $1,206.40
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.27 / $226.00 / $399.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.79 / $217.82 / $368.48
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.21 / $178.25 / $308.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.65 / $328.28 / $392.62
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.30 / $168.00 / $376.90