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South Dakota rates for HCPCS 50081

Percutaneous nephrolithotomy or pyelolithotomy, lithotripsy, stone extraction, antegrade ureteroscopy, antegrade stent placement and nephrostomy tube placement, when performed, including imaging guidance; complex (eg, stone[s] > 2 cm, branching stones, stones in multiple locations, ureter stones, complicated anatomy)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,060.90 / $1,060.90 / $4,338.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,365.09 / $1,792.92 / $3,418.51
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,200.00 / $3,337.08 / $8,958.90
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,559.59 / $2,066.29 / $2,174.88
Sanford Health Plan
Facility/Professional
Professional
Modifier
80
Low / Median / High Price
$475.63 / $475.63 / $475.63
Sanford Health Plan
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$475.63 / $475.63 / $475.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00