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South Dakota rates for HCPCS 72131

Ct Lumbar Spine W/O Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$48.16 / $48.16 / $48.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.44 / $247.93 / $353.78
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.59 / $46.89 / $149.40
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$78.52 / $201.03 / $550.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.85 / $307.95 / $384.94
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$87.54 / $107.05 / $133.81
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$164.30 / $200.91 / $251.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.18 / $288.56 / $1,609.32
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$60.03 / $92.70 / $379.76
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$127.04 / $195.86 / $1,345.00
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$156.93 / $156.93 / $156.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.39 / $359.75 / $509.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.03 / $253.56 / $327.27
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$60.92 / $79.44 / $90.57
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$122.50 / $164.31 / $250.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.58 / $288.56 / $361.58
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$55.92 / $90.20 / $105.04
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$102.66 / $190.56 / $261.54
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.80 / $297.50 / $297.50
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$89.80 / $105.70 / $105.70
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$163.00 / $191.80 / $191.80