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South Dakota rates for HCPCS C9761

Cystourethroscopy With Ureteroscopy And/Or Pyelo-Scopy With Lithotripsy And Ureteral Catheterization For Steerable Vacuum Aspiration Of The Kidney Collecting System Ureter Bladder And Urethra Ifapplicable (Must Use A Steerable Ureteral Catheter) (Desc Rvsd 1/1/23)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,338.00 / $4,338.00 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,804.54 / $9,804.54 / $9,804.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $16,569.68 / $16,569.68
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,937.53 / $7,954.64 / $11,519.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00