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South Dakota rates for HCPCS 50725

Ureterolysis for retrocaval ureter, with reanastomosis of upper urinary tract or vena cava

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,039.05 / $1,039.05 / $1,039.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$936.20 / $1,039.05 / $3,168.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,399.54 / $2,456.50 / $3,070.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,338.77 / $1,755.99 / $2,965.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,334.24 / $2,223.73 / $8,473.45
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,741.29 / $2,717.58 / $3,351.65
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,887.00 / $2,399.54 / $2,911.21
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,379.58 / $1,852.00 / $2,132.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,334.24 / $2,181.66 / $3,069.67
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,115.80 / $2,489.19 / $2,588.80