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South Dakota rates for HCPCS 54328

1-Stage Distal Hypospadias Repair (With Or Without Chordee Or Circumcision); With Extensive Dissection To Correct Chordee And Urethroplasty With Local Skin Flaps, Skin Graft Patch, And/Or Island Flap

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$840.63 / $840.63 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$780.57 / $840.63 / $2,699.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,045.12 / $2,095.78 / $2,619.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,116.22 / $1,420.66 / $2,602.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.93 / $1,914.88 / $9,714.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,636.00 / $2,451.17 / $3,079.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,699.00 / $2,045.12 / $2,476.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,175.02 / $1,564.80 / $1,817.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,255.94 / $2,010.62 / $2,614.21
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,771.60 / $2,084.19 / $2,167.50