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South Dakota rates for HCPCS 71552

Mri Chest W/O & W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$109.41 / $109.41 / $109.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.74 / $495.41 / $804.13
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$94.81 / $140.00 / $176.40
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$335.00 / $368.50 / $638.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$916.67 / $1,120.89 / $1,401.11
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$198.56 / $242.79 / $303.49
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$718.11 / $878.09 / $1,097.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$671.26 / $1,035.15 / $5,967.97
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$135.25 / $208.51 / $937.83
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$536.20 / $826.64 / $5,400.50
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$354.03 / $354.03 / $354.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,003.11 / $1,097.17 / $1,612.15
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$678.04 / $877.03 / $1,059.69
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$138.88 / $184.53 / $207.01
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$531.83 / $680.36 / $858.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.20 / $1,035.15 / $1,225.71
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$124.41 / $202.88 / $243.66
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$454.57 / $826.64 / $1,015.25
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,062.30 / $1,249.80 / $1,249.80
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$238.20 / $280.30 / $280.30
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$824.10 / $969.50 / $969.50