go back

South Dakota rates for HCPCS 73221

Mri Any Jt Upper Extremity W/O Contrast Matrl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$66.06 / $66.06 / $66.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.62 / $190.01 / $522.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$62.14 / $148.50 / $384.48
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$95.01 / $95.01 / $110.86
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$132.84 / $375.20 / $2,454.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.12 / $485.59 / $606.99
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$119.26 / $145.83 / $182.29
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$277.86 / $339.76 / $424.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.45 / $427.76 / $2,789.74
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.90 / $126.82 / $542.85
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$195.20 / $300.94 / $2,451.15
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$219.10 / $219.10 / $219.10
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$441.21 / $518.78 / $871.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.18 / $381.05 / $467.20
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$83.23 / $108.37 / $123.56
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$199.94 / $263.66 / $329.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.06 / $427.76 / $536.00
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$76.30 / $123.39 / $147.04
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$173.76 / $300.94 / $369.55
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.50 / $543.00 / $543.00
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$142.19 / $167.30 / $167.30
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$319.39 / $375.70 / $375.70