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South Dakota rates for HCPCS 72193

Ct Pelvis W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$56.11 / $56.11 / $56.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.24 / $299.31 / $495.07
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.78 / $58.49 / $201.14
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$163.46 / $246.13 / $357.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$443.43 / $542.21 / $677.77
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$102.13 / $124.89 / $156.11
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$341.29 / $417.33 / $521.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.68 / $452.14 / $1,817.09
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$69.66 / $107.39 / $364.90
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$203.00 / $338.34 / $1,526.12
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$183.09 / $183.09 / $183.09
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.93 / $519.90 / $653.34
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.76 / $379.43 / $447.38
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.80 / $92.49 / $105.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$203.27 / $289.80 / $342.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.62 / $452.14 / $496.87
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$65.12 / $107.39 / $124.23
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$216.50 / $335.43 / $355.25
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$442.80 / $521.00 / $521.00
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.60 / $123.10 / $123.10
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$338.20 / $397.90 / $397.90