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South Dakota rates for HCPCS 72196

Mri Pelvis W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$83.93 / $83.93 / $83.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.30 / $295.42 / $546.25
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$72.41 / $83.93 / $154.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$178.89 / $211.50 / $368.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$523.36 / $639.95 / $799.94
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$151.62 / $185.39 / $231.74
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$371.74 / $454.56 / $568.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.49 / $578.88 / $3,389.77
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.08 / $160.44 / $657.14
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$271.95 / $424.46 / $2,953.83
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$272.52 / $272.52 / $272.52
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.39 / $702.79 / $1,059.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.90 / $513.20 / $680.15
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$103.49 / $137.88 / $157.19
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$276.83 / $371.32 / $533.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.74 / $578.88 / $826.68
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$96.67 / $160.44 / $210.83
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$234.07 / $418.43 / $685.67
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$608.20 / $715.50 / $715.50
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$180.90 / $212.80 / $212.80
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$427.30 / $502.70 / $502.70