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South Dakota rates for HCPCS 72133

Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$43.65 / $61.66 / $61.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $239.88 / $436.52
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $64.57 / $112.20
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$128.82 / $169.82 / $371.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $478.63 / $602.56
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$112.20 / $138.04 / $173.78
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$275.42 / $338.84 / $426.58
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $416.87 / $776.25
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.10 / $107.15 / $524.81
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$199.53 / $309.03 / $2,398.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $426.58 / $588.84
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$120.23 / $125.89 / $147.91
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$275.42 / $302.00 / $436.52
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $467.74 / $467.74
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$131.83 / $131.83 / $131.83
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$338.84 / $338.84 / $338.84
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $389.05 / $537.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.13 / $97.72 / $114.82
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$190.55 / $275.42 / $457.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $426.58 / $588.84
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$64.57 / $107.15 / $138.04
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$173.78 / $309.03 / $457.09
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $457.09 / $457.09
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$114.82 / $134.90 / $134.90
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$269.15 / $316.23 / $316.23