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South Dakota rates for HCPCS 73720

Magnetic resonance (eg, proton) imaging, lower 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
$104.04 / $104.04 / $104.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.65 / $371.24 / $598.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$97.93 / $234.07 / $278.57
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$225.75 / $335.00 / $422.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.58 / $802.85 / $1,003.56
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$189.68 / $231.93 / $289.92
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$466.90 / $570.91 / $713.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.50 / $728.44 / $5,978.92
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$128.76 / $198.51 / $733.09
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$343.74 / $529.92 / $5,438.76
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$336.47 / $336.47 / $336.47
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$729.41 / $885.56 / $1,437.58
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$484.80 / $629.97 / $831.17
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$125.41 / $173.06 / $197.30
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$347.26 / $465.77 / $650.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$415.43 / $728.44 / $1,011.72
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$120.24 / $198.51 / $261.02
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$295.19 / $529.92 / $796.58
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$763.00 / $897.70 / $897.70
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$227.10 / $267.10 / $267.10
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$536.00 / $630.60 / $630.60