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South Dakota rates for HCPCS 50953

Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without dilation of ureter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$304.61 / $383.58 / $383.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.69 / $633.72 / $1,021.48
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$723.00 / $985.48 / $2,896.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.43 / $627.49 / $784.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00