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South Dakota rates for HCPCS 53405

Urethroplasty 2nd Stage W/Urinary Diversion

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$826.83 / $826.83 / $3,073.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.25 / $826.83 / $2,510.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,909.01 / $1,957.10 / $2,446.37
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,065.71 / $1,397.34 / $2,336.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,045.86 / $1,743.12 / $6,500.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,507.00 / $2,285.14 / $4,555.17
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,483.00 / $1,909.01 / $2,313.11
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,092.84 / $1,454.56 / $1,696.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,045.86 / $1,734.28 / $2,433.54
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,683.30 / $1,980.40 / $2,059.60