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South Dakota rates for HCPCS 72191

Ct Angiography Pelvis W/Contrast/Noncontrast

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$86.37 / $86.37 / $86.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.13 / $434.01 / $680.76
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.97 / $86.37 / $119.82
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$163.16 / $224.56 / $508.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$571.42 / $726.06 / $907.57
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$157.33 / $192.37 / $240.47
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$391.39 / $533.67 / $667.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$368.71 / $601.58 / $3,081.89
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.54 / $165.78 / $554.78
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$260.47 / $434.12 / $2,625.91
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$288.26 / $288.26 / $288.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.32 / $645.07 / $864.71
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.10 / $509.76 / $602.84
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$110.27 / $143.55 / $163.66
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$260.99 / $370.63 / $442.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.28 / $601.58 / $683.63
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.26 / $161.30 / $191.88
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$274.02 / $434.12 / $467.53
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$594.90 / $699.90 / $699.90
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$162.40 / $191.00 / $191.00
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$432.50 / $508.90 / $508.90