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South Dakota rates for HCPCS 72141

Mri Spinal Canal Cervical W/O Contrast Matrl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$71.77 / $71.77 / $71.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.18 / $475.00 / $598.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.20 / $140.00 / $405.84
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$89.09 / $89.09 / $103.94
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$115.99 / $335.00 / $422.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.48 / $453.01 / $566.26
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$130.05 / $159.02 / $198.77
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$240.43 / $293.99 / $367.49
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.14 / $404.13 / $2,901.82
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$88.96 / $137.49 / $558.07
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$172.96 / $266.64 / $2,498.98
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$252.33 / $252.33 / $252.33
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$412.74 / $492.45 / $908.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.16 / $356.47 / $442.43
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$90.10 / $118.59 / $135.19
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$175.45 / $228.02 / $293.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.88 / $404.13 / $508.13
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$83.09 / $137.49 / $159.69
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$151.79 / $266.64 / $317.58
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.80 / $508.00 / $508.00
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$155.60 / $183.00 / $183.00
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$276.20 / $324.89 / $324.89