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South Dakota rates for HCPCS 50961

Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.63 / $372.55 / $372.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.97 / $606.29 / $993.32
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$705.00 / $959.42 / $4,412.80
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$422.63 / $604.85 / $754.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00