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South Dakota rates for HCPCS 50728

Revision of urinary-cutaneous anastomosis (any type urostomy); with repair of fascial defect and hernia

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$665.14 / $665.14 / $665.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.35 / $665.14 / $982.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,535.65 / $1,578.46 / $1,973.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$858.50 / $1,124.08 / $1,864.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$833.57 / $1,420.12 / $5,648.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,085.89 / $1,735.85 / $2,248.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,303.00 / $1,535.65 / $1,878.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$902.66 / $1,161.56 / $1,364.96
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
$833.57 / $1,389.28 / $2,024.82
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,354.10 / $1,593.10 / $1,656.80