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South Dakota rates for HCPCS 50705

Ureteral Embolization/Occlusion W/Img Gid Rs&I

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$163.46 / $1,891.21 / $1,891.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.81 / $1,600.01 / $1,891.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.32 / $486.81 / $5,225.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.46 / $821.00 / $4,366.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,159.10 / $4,541.92 / $13,214.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$431.13 / $2,911.29 / $5,977.65
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.10 / $2,964.42 / $5,067.72
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.21 / $2,070.32 / $3,415.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,324.23 / $3,754.53 / $5,436.26
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.90 / $412.20 / $4,145.89