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South Dakota rates for HCPCS 73701

Ct Lower Extremity W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$56.11 / $56.11 / $56.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.04 / $283.45 / $338.16
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.78 / $58.49 / $156.60
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$106.81 / $254.24 / $368.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.80 / $397.16 / $496.45
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$102.13 / $124.89 / $156.11
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$222.67 / $272.27 / $340.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.38 / $361.34 / $1,638.03
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$69.66 / $107.39 / $376.34
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$164.72 / $253.95 / $1,335.34
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$183.28 / $183.28 / $183.28
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.80 / $470.79 / $510.77
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.67 / $326.08 / $372.82
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.80 / $92.49 / $105.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$165.91 / $222.53 / $275.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.91 / $361.34 / $454.46
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$65.11 / $104.49 / $124.24
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$139.80 / $253.95 / $338.34
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.39 / $382.80 / $382.80
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.60 / $123.10 / $123.10
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$220.80 / $259.70 / $259.70