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South Dakota rates for HCPCS 52315

Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); complicated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$256.32 / $462.12 / $462.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.64 / $431.54 / $685.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$604.58 / $755.73 / $1,291.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$343.85 / $692.85 / $1,080.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$493.07 / $1,157.04 / $4,764.99
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$643.84 / $942.36 / $1,679.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$621.44 / $833.81 / $1,091.29
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.62 / $651.59 / $873.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.36 / $838.04 / $1,303.61
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$522.40 / $639.20 / $1,060.80