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South Dakota rates for HCPCS 70496

Ct Angiography Head W/Contrast/Noncontrast

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$84.63 / $84.63 / $84.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.60 / $431.44 / $615.49
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.97 / $84.63 / $356.89
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$163.27 / $351.12 / $509.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$539.22 / $659.35 / $824.18
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$153.52 / $187.72 / $234.65
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$385.70 / $471.63 / $589.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.46 / $552.85 / $3,234.12
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.94 / $161.78 / $559.72
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$248.40 / $391.07 / $2,749.60
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$282.32 / $282.32 / $282.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$548.94 / $639.65 / $780.65
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.30 / $477.75 / $586.13
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.27 / $139.58 / $159.13
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$248.93 / $335.36 / $409.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$339.13 / $537.91 / $618.55
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$97.86 / $157.41 / $183.86
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$241.27 / $391.07 / $453.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$540.40 / $635.70 / $635.70
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$157.90 / $185.70 / $185.70
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$382.50 / $450.00 / $450.00