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South Dakota rates for HCPCS 70552

Mri Brain Brain Stem W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$86.39 / $86.39 / $86.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.14 / $475.00 / $661.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.86 / $154.00 / $232.29
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$126.57 / $126.57 / $148.16
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$178.28 / $238.28 / $462.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$527.79 / $645.38 / $806.73
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$156.69 / $191.60 / $239.50
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$371.11 / $453.78 / $567.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.33 / $575.54 / $3,445.62
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.10 / $165.11 / $672.00
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$266.23 / $410.44 / $2,996.90
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$279.49 / $279.49 / $279.49
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$586.39 / $700.06 / $1,076.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.17 / $506.43 / $634.97
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$109.40 / $142.41 / $162.37
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$270.94 / $352.17 / $454.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.14 / $575.54 / $700.26
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$99.86 / $165.11 / $192.52
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$233.28 / $410.44 / $488.23
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$613.40 / $721.70 / $721.70
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$186.90 / $219.80 / $219.80
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$426.60 / $501.80 / $501.80