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South Dakota rates for HCPCS 72133

Ct Lumbar Spine W/O & W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$61.49 / $61.49 / $61.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.80 / $335.70 / $383.66
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.19 / $57.89 / $92.28
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$131.61 / $243.40 / $325.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.80 / $469.30 / $586.62
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$111.02 / $135.75 / $169.68
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$272.77 / $333.55 / $416.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.42 / $427.68 / $2,293.84
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$75.88 / $116.98 / $523.40
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$201.54 / $310.70 / $2,412.00
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$202.05 / $202.05 / $202.05
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.27 / $584.30 / $718.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.77 / $387.49 / $459.76
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.66 / $101.00 / $115.15
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$203.05 / $272.33 / $378.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.26 / $427.68 / $542.76
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$71.09 / $113.81 / $135.34
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$172.16 / $310.70 / $415.88
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.40 / $452.20 / $452.20
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$114.20 / $134.40 / $134.40
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$270.20 / $317.89 / $317.89