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South Dakota rates for HCPCS 70487

Computed tomography, maxillofacial area; with contrast material(s)

Facilitymedian $54 · 10th–90th $39$540%50%10th$54Professionalmedian $155 · 10th–90th $54$3390%5%10th90th$155$50.0$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$38.90 / $53.70 / $53.70
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $186.21 / $457.09
Aetna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$51.29 / $109.65 / $257.04
Aetna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$93.33 / $120.23 / $380.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $371.54 / $467.74
Cigna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$100.00 / $125.89 / $154.88
Cigna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$194.98 / $245.47 / $309.03
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $269.15 / $1,698.24
Medica
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$56.23 / $91.20 / $389.05
Medica
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$112.20 / $190.55 / $2,041.74
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $331.13 / $371.54
Midlands
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$107.15 / $112.20 / $131.83
Midlands
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$199.53 / $218.78 / $239.88
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $338.84 / $338.84
Midlands
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$117.49 / $117.49 / $117.49
Midlands
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$223.87 / $223.87 / $223.87
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $275.42 / $457.09
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$66.07 / $91.20 / $102.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$131.83 / $186.21 / $371.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $309.03 / $416.87
United
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$61.66 / $100.00 / $141.25
United
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$123.03 / $208.93 / $288.40
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $346.74 / $346.74
Wellmark
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$102.33 / $120.23 / $120.23
Wellmark
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$194.98 / $229.09 / $229.09