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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
$320.70 / $1,363.37 / $1,363.37
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$409.00 / $1,244.78 / $3,337.26
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$830.98 / $2,482.96 / $3,989.30
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$482.78 / $1,423.67 / $2,489.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00