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South Dakota rates for HCPCS 29015

Application of Risser jacket, localizer, body; including head

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $302.00 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $281.84 / $467.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $524.81 / $912.01
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $389.05 / $660.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $537.03 / $2,238.72
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $407.38 / $660.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $380.19 / $602.56
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $398.11 / $602.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $389.05 / $758.58
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $436.52 / $724.44