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South Dakota rates for HCPCS 72141

Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$70.79 / $70.79 / $70.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $426.58 / $977.24
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.07 / $120.23 / $239.88
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$870.96 / $870.96 / $870.96
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$123.03 / $302.00 / $812.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $467.74 / $575.44
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$128.82 / $162.18 / $204.17
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$239.88 / $302.00 / $380.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $380.19 / $851.14
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.28 / $138.04 / $208.93
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$151.36 / $257.04 / $2,511.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $416.87 / $489.78
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$141.25 / $147.91 / $173.78
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$245.47 / $263.03 / $323.59
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $446.68
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$154.88 / $154.88 / $154.88
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$288.40 / $288.40 / $288.40
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $371.54 / $676.08
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$87.10 / $117.49 / $134.90
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$162.18 / $239.88 / $575.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $407.38 / $562.34
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.13 / $125.89 / $181.97
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$151.36 / $269.15 / $380.19
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $512.86 / $512.86
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$154.88 / $181.97 / $181.97
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$275.42 / $323.59 / $323.59