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South Dakota rates for HCPCS 50705

Ureteral embolization or occlusion, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $1,905.46 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $1,584.89 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $3,019.95 / $5,370.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $812.83 / $4,365.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $3,630.78 / $13,182.57
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $467.74 / $4,570.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $371.54 / $3,890.45
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $2,454.71 / $3,388.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $562.34 / $5,248.07
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $416.87 / $4,168.69