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South Dakota rates for HCPCS 71275

Ct Angiography Chest W/Contrast/Noncontrast

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$87.78 / $87.78 / $87.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.47 / $438.87 / $625.24
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$79.12 / $87.03 / $237.63
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$163.27 / $350.77 / $2,820.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$550.00 / $672.53 / $840.66
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$159.86 / $195.48 / $244.35
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$390.14 / $477.06 / $596.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.08 / $564.88 / $3,183.14
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$109.37 / $168.46 / $334.80
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$252.71 / $396.42 / $2,699.58
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$301.14 / $301.14 / $301.14
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$556.23 / $648.00 / $795.05
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.78 / $487.95 / $555.69
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$108.60 / $145.82 / $166.25
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$253.24 / $340.78 / $434.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.90 / $549.61 / $623.26
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$101.86 / $163.91 / $191.39
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$244.06 / $396.42 / $457.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.29 / $648.50 / $648.50
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$164.90 / $194.00 / $194.00
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$386.30 / $454.50 / $454.50