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South Dakota rates for HCPCS 51728

Complex Cystometrogram Voiding Pressure Studies

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$98.16 / $98.16 / $98.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$339.81 / $339.81 / $568.13
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$98.16 / $110.37 / $157.30
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$324.64 / $324.64 / $401.40
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$229.43 / $235.11 / $410.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$739.44 / $796.24 / $995.30
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$216.76 / $229.83 / $287.29
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$514.72 / $566.41 / $708.01
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.79 / $641.39 / $2,698.08
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$125.63 / $209.38 / $770.56
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$254.87 / $452.59 / $1,927.52
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$510.81 / $739.44 / $982.41
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$413.00 / $558.70 / $657.25
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$130.18 / $173.62 / $197.95
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$282.83 / $390.43 / $459.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.50 / $745.99 / $997.72
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$115.16 / $203.06 / $293.69
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$276.23 / $452.59 / $704.03
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$652.00 / $767.10 / $797.80
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$196.40 / $231.00 / $240.30
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$455.60 / $536.00 / $557.50