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South Dakota rates for HCPCS 50694

Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; new access, without separate nephrostomy catheter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $1,148.15 / $4,365.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $1,380.38 / $2,754.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $630.96 / $2,570.40
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $1,513.56 / $2,089.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28