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South Dakota rates for HCPCS 50695

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, with separate nephrostomy catheter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $1,445.44 / $7,585.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $1,659.59 / $3,235.94
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $812.83 / $3,090.30
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $1,819.70 / $2,511.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28