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South Dakota rates for HCPCS 70481

Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$38.90 / $53.70 / $53.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $234.42 / $457.09
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $75.86 / $204.17
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$120.23 / $177.83 / $354.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $436.52 / $549.54
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.00 / $125.89 / $154.88
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$251.19 / $316.23 / $398.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $407.38 / $794.33
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$67.61 / $102.33 / $562.34
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$199.53 / $316.23 / $1,548.82
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $389.05 / $602.56
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.15 / $112.20 / $162.18
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$257.04 / $275.42 / $436.52
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $457.09
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$117.49 / $117.49 / $117.49
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$338.84 / $338.84 / $338.84
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $354.81 / $537.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$69.18 / $97.72 / $114.82
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$173.78 / $251.19 / $446.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $416.87 / $602.56
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.10 / $104.71 / $147.91
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$158.49 / $316.23 / $457.09
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $416.87 / $416.87
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$102.33 / $120.23 / $120.23
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$251.19 / $295.12 / $295.12