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South Dakota rates for HCPCS 72157

Mri Spinal Canal Thoracic W/O & W/Contr Matrl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$110.82 / $110.82 / $110.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.04 / $475.00 / $600.08
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$97.95 / $168.21 / $596.29
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$203.70 / $335.00 / $422.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$623.59 / $762.51 / $953.14
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$201.73 / $246.67 / $308.33
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$421.86 / $515.84 / $644.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$445.54 / $686.87 / $6,195.24
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$137.44 / $212.34 / $931.20
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$307.80 / $474.53 / $5,551.18
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$403.34 / $403.34 / $403.34
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$694.54 / $834.54 / $1,485.23
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$456.25 / $599.85 / $755.30
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$140.62 / $184.41 / $210.24
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$310.24 / $400.10 / $523.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.05 / $686.87 / $861.88
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$128.63 / $212.34 / $279.08
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$266.42 / $461.70 / $582.79
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$726.60 / $854.80 / $854.80
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$241.90 / $284.60 / $284.60
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$484.60 / $570.10 / $570.10