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South Dakota rates for HCPCS 50572

Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without dilation of ureter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.14 / $494.14 / $2,290.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.93 / $494.14 / $1,532.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,145.54 / $1,165.53 / $1,456.92
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$513.95 / $835.10 / $1,430.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$633.95 / $1,056.58 / $3,905.52
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$552.88 / $1,249.92 / $1,604.92
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$897.00 / $1,145.54 / $1,389.55
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$666.00 / $887.71 / $1,018.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,643.00 / $1,643.00 / $1,643.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.12 / $1,029.63 / $1,474.76
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,010.10 / $1,188.40 / $1,235.90