Urology · South Dakota

Urology commercial reimbursement in South Dakota

How South Dakota urology rates compare with the national market.

Urology South Dakota

Urology in South Dakota

37 codes · 34 sampled providers

Index vs national

116

16% above

Rank among states

12 of 50

1 = highest

Codes above national

32 of 37

median code at 116%

Providers

sampled

What the data shows

Urology ranks 12th of 50 states in South Dakota with an index of 116 (100 = the specialty's national median), across 37 codes and 34 sampled providers.

Of the 37 urology codes with enough data in South Dakota, 32 pay above the national median and 5 below; the typical code sits at 116% of the national median.

Largest premium over the national median: CPT 76856 (Us exam pelvic complete) at 143%; largest discount: CPT 52000 (Cystourethroscopy) at 90%.

Measured against Medicare, South Dakota urology rates have a median of 216% of the Medicare rate across these codes.

Codes above and below the national median

The five largest gaps in each direction

Highest vs national

Code	South Dako	National	Gap	Prov.
76856 Us exam pelvic complete	$212	$148	+44%	33
76770 Us exam abdo back wall comp	$214	$153	+40%	33
51728 Cystometrogram w/vp	$726	$520	+40%	33
74178 Ct abd&plv wo cntr flwd cntr	$686	$498	+38%	33
51729 Cystometrogram w/vp&up	$763	$554	+38%	33

Lowest vs national

Code	South Dako	National	Gap	Prov.
52000 Cystourethroscopy	$190	$210	-10%	33
51700 Irrigation of bladder	$71	$77	-8%	33
51720 Treatment of bladder lesion	$103	$111	-7%	33
51702 Insert temp bladder cath	$60	$61	-2%	33
99212 Office o/p est sf 10 min	$51	$52	-2%	34

All urology codes in South Dakota

Median across payers vs the specialty's national median and the Medicare rate; sorted by premium

Code	South Dakota	National	Gap	% of Medicare	Providers	TINs
CPT 76856 Us exam pelvic complete	$212	$148	+43%	202%	33	85
CPT 76770 Us exam abdo back wall comp	$214	$153	+40%	202%	33	85
CPT 51728 Cystometrogram w/vp	$726	$520	+40%	216%	33	85
CPT 74178 Ct abd&plv wo cntr flwd cntr	$686	$498	+38%	203%	33	85
CPT 51729 Cystometrogram w/vp&up	$763	$554	+38%	216%	33	85
CPT 51798 Us urine capacity measure	$29	$21	+34%	226%	33	74
CPT 76872 Us transrectal	$251	$188	+33%	209%	33	85
CPT 52356 Cysto/uretero w/lithotripsy	$859	$657	+31%	235%	33	85
CPT 76857 Us exam pelvic limited	$97	$75	+30%	189%	33	85
CPT 55874 Tprnl plmt biodegrdabl matrl	$328	$257	+28%	230%	33	85
CPT 76775 Us exam abdo back wall lim	$117	$92	+27%	193%	33	85
CPT 93000 Electrocardiogram complete	$32	$26	+25%	209%	33	80
CPT 99205 Office o/p new hi 60 min	$319	$257	+24%	135%	34	85
CPT 99204 Office o/p new mod 45 min	$244	$197	+24%	138%	34	85
CPT 20610 Drain/inj joint/bursa w/o us	$105	$86	+23%	153%	34	85
CPT 50590 Fragmenting of kidney stone	$1,274	$1,065	+20%	168%	33	85
CPT 52649 Prostate laser enucleation	$1,607	$1,355	+19%	245%	33	85
CPT 99426 Prin care mgmt staff 1st 30	$90	$77	+18%	133%	33	85
CPT 55866 Laps surg prst8ect rpbic rad	$2,603	$2,237	+16%	241%	33	85
CPT 99203 Office o/p new low 30 min	$144	$125	+15%	122%	34	85
CPT 99215 Office o/p est hi 40 min	$212	$187	+13%	110%	34	85
CPT 99214 Office o/p est mod 30 min	$150	$134	+12%	111%	34	85
CPT 52601 Prostatectomy (turp)	$1,287	$1,181	+9%	245%	33	85
CPT 52287 Cystoscopy chemodenervation	$396	$367	+8%	266%	33	85
CPT 52648 Laser surgery of prostate	$1,618	$1,508	+7%	306%	33	85
CPT 52281 Cystoscopy and treatment	$356	$334	+7%	261%	33	85
CPT 99213 Office o/p est low 20 min	$97	$92	+6%	102%	34	85
CPT 52224 Cystoscopy and treatment	$479	$459	+4%	272%	33	85
CPT 52310 Cystoscopy and treatment	$329	$317	+4%	245%	33	85
CPT 99490 Chrnc care mgmt staff 1st 20	$62	$60	+3%	94%	33	85
CPT 64566 Neuroeltrd stim post tibial	$71	$69	+2%	272%	33	85
CPT 52332 Cystoscopy and treatment	$364	$360	+1%	261%	33	85
CPT 99212 Office o/p est sf 10 min	$51	$52	-2%	86%	34	85
CPT 51702 Insert temp bladder cath	$60	$61	-2%	262%	33	85
CPT 51720 Treatment of bladder lesion	$103	$111	-7%	272%	33	85
CPT 51700 Irrigation of bladder	$71	$77	-8%	272%	33	85
CPT 52000 Cystourethroscopy	$190	$210	-10%	267%	33	85

Frequently asked questions

How do South Dakota urology rates compare with the rest of the country?

South Dakota ranks 12th of 50 states with an index of 116; 32 of 37 codes are above the national median.

Which urology code has the biggest premium in South Dakota?

CPT 76856 (Us exam pelvic complete), at 143% of the national median.

Are these Medicare or commercial rates?

Commercial in-network negotiated rates from four national payers' published files; the Medicare comparison column uses the CY2026 Medicare physician fee schedule.

Methodology

How these numbers are calculated

Source: in-network negotiated-rate files published under the federal Transparency in Coverage rule, August 2026 snapshot: UnitedHealthcare Choice plans (74 files); Aetna commercial plans (70 files); Cigna national PPO (1 files); BCBS licensees' own-network files (5,387 files). Payer comparisons describe these files, not each payer's entire book of business.
Sample: rates come from a random sample of up to 150 providers per state and specialty. Counts on this page are sampled providers and TINs, not totals.
Which providers count: only providers in a specialty relevant to the code, because a rate in a payer file attaches to a provider group and is listed under every provider in that group.
Filters: fee-for-service, professional billing class, no modifier, negotiated or fee-schedule dollar rates. Rates outside 1% to 1,000% of the Medicare rate are excluded.
Statistic: one median rate per provider, then percentiles across providers. A cell is shown only with at least 15 sampled providers and 4 TINs.
Medicare benchmark: CY2026 national physician fee schedule, non-QPP conversion factor, unadjusted for locality. Where the non-facility rate is more than twice the facility rate (office rates that include device or supply cost), the facility rate is used so comparisons are like for like.

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