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South Dakota rates for HCPCS 72132

Computed tomography, lumbar spine; with contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$58.91 / $58.91 / $58.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.72 / $315.56 / $450.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.23 / $56.03 / $264.60
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$106.50 / $259.52 / $376.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.88 / $403.36 / $504.21
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.21 / $131.09 / $163.87
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$222.67 / $272.27 / $340.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.71 / $364.93 / $1,882.38
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$73.12 / $112.98 / $434.24
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$163.43 / $251.95 / $1,906.00
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$191.71 / $191.71 / $191.71
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.48 / $486.32 / $593.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.68 / $329.15 / $380.58
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.65 / $97.03 / $110.62
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$165.91 / $222.53 / $302.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.72 / $355.07 / $458.78
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$68.30 / $112.98 / $156.83
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$139.41 / $251.95 / $336.92
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.50 / $388.80 / $388.80
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$109.70 / $129.10 / $129.10
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$220.80 / $259.70 / $259.70