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South Dakota rates for HCPCS 72142

Mri Spinal Canal Cervical W/Contrast Matrl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$86.74 / $86.74 / $86.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.85 / $302.14 / $522.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$75.28 / $86.74 / $154.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$182.57 / $215.41 / $368.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.04 / $655.47 / $819.33
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$157.96 / $193.15 / $241.44
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$378.09 / $462.32 / $577.90
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$381.56 / $588.24 / $3,482.54
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.21 / $165.78 / $642.27
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$274.02 / $422.46 / $2,996.90
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$302.42 / $302.42 / $302.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$596.33 / $712.81 / $1,091.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.16 / $515.03 / $642.04
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$109.40 / $144.12 / $164.31
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$277.33 / $358.93 / $461.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$339.53 / $588.24 / $711.22
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.66 / $165.78 / $201.20
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$238.87 / $422.46 / $518.71
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$623.79 / $733.90 / $733.90
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$189.10 / $222.50 / $222.50
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$434.70 / $511.50 / $511.50