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South Dakota rates for HCPCS 72190

Radiologic examination, pelvis; complete, minimum of 3 views

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$12.40 / $12.40 / $12.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.10 / $43.61 / $70.66
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$10.44 / $13.65 / $40.04
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$27.38 / $35.11 / $92.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.93 / $97.74 / $122.17
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$22.20 / $27.15 / $33.94
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$56.86 / $70.59 / $88.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $75.28 / $271.52
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$13.09 / $22.91 / $97.41
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$32.47 / $51.67 / $210.00
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$36.65 / $36.65 / $36.65
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $88.14 / $105.69
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.91 / $63.12 / $81.51
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$13.36 / $18.88 / $23.29
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$32.18 / $44.24 / $58.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.83 / $75.28 / $92.79
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$14.25 / $19.84 / $23.61
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$32.47 / $50.27 / $59.06
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.90 / $84.60 / $84.60
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$20.60 / $24.20 / $24.20
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$51.40 / $60.50 / $60.50