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South Dakota rates for HCPCS 72198

Magnetic resonance angiography, pelvis, with or without contrast material(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$85.11 / $85.11 / $85.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $478.63 / $1,862.09
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.28 / $125.89 / $281.84
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$245.47 / $346.74 / $616.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $831.76 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$158.49 / $194.98 / $245.47
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$501.19 / $630.96 / $794.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $645.65 / $1,148.15
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$89.13 / $151.36 / $602.56
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$316.23 / $537.03 / $2,570.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $741.31 / $870.96
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$169.82 / $181.97 / $208.93
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$512.86 / $549.54 / $660.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $794.33 / $794.33
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$181.97 / $181.97 / $181.97
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$602.56 / $602.56 / $602.56
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $660.69 / $794.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.71 / $138.04 / $162.18
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$338.84 / $501.19 / $691.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $707.95 / $977.24
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$91.20 / $151.36 / $218.78
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$316.23 / $537.03 / $741.31
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $912.01 / $912.01
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$186.21 / $223.87 / $223.87
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$575.44 / $676.08 / $676.08