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South Dakota rates for HCPCS 73220

Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$104.71 / $104.71 / $104.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $457.09 / $1,698.24
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$95.50 / $158.49 / $338.84
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$302.00 / $416.87 / $794.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,000.00 / $1,258.93
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$190.55 / $239.88 / $295.12
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$602.56 / $758.58 / $954.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $851.14 / $1,412.54
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.15 / $194.98 / $302.00
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$398.11 / $676.08 / $5,495.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $891.25 / $1,096.48
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$204.17 / $218.78 / $251.19
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$616.60 / $660.69 / $831.76
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $977.24 / $977.24
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$223.87 / $223.87 / $223.87
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$758.58 / $758.58 / $758.58
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $812.83 / $1,023.29
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$117.49 / $165.96 / $199.53
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$416.87 / $602.56 / $870.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $870.96 / $1,174.90
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.15 / $181.97 / $263.03
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$389.05 / $691.83 / $891.25
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,096.48 / $1,096.48
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$229.09 / $269.15 / $269.15
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$691.83 / $812.83 / $812.83