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South Dakota rates for HCPCS 73222

Mri Any Jt Upper Extremity W/Contrast Matrl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$78.79 / $78.79 / $78.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.30 / $475.00 / $533.05
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.58 / $140.00 / $340.87
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$225.44 / $335.00 / $414.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$607.10 / $742.34 / $927.93
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$143.37 / $175.31 / $219.14
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$463.73 / $567.04 / $708.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$442.62 / $682.37 / $3,348.15
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$97.57 / $151.11 / $586.14
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$344.60 / $531.26 / $2,941.88
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$256.52 / $256.52 / $256.52
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$672.47 / $825.17 / $1,086.21
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$449.13 / $580.79 / $701.76
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$99.54 / $132.54 / $148.13
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$344.05 / $440.05 / $551.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.27 / $663.93 / $799.13
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$91.48 / $151.11 / $170.75
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$294.79 / $531.26 / $652.50
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$703.50 / $827.60 / $827.60
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$170.50 / $200.60 / $200.60
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$533.00 / $627.10 / $627.10