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South Dakota rates for HCPCS 72192

Ct Pelvis W/O Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$52.60 / $52.60 / $52.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.93 / $246.41 / $351.09
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.24 / $51.10 / $261.89
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$78.20 / $196.81 / $285.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.83 / $316.49 / $395.61
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$95.79 / $117.13 / $146.41
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$163.03 / $199.35 / $249.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.49 / $270.54 / $1,593.12
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$65.33 / $100.71 / $325.83
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$110.16 / $169.83 / $1,318.35
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$172.07 / $172.07 / $172.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.93 / $325.27 / $503.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.91 / $237.88 / $293.29
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.50 / $86.81 / $98.98
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$109.40 / $147.94 / $187.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.38 / $270.54 / $300.06
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$61.12 / $97.99 / $114.83
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$102.26 / $165.24 / $184.04
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.89 / $305.80 / $305.80
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$98.20 / $115.50 / $115.50
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$161.69 / $190.30 / $190.30