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South Dakota rates for HCPCS 73722

Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$77.62 / $77.62 / $77.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $478.63 / $812.83
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.62 / $144.54 / $354.81
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$269.15 / $338.84 / $616.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $758.58 / $954.99
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$144.54 / $177.83 / $223.87
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$467.74 / $588.84 / $724.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $645.65 / $1,096.48
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.28 / $138.04 / $229.09
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$302.00 / $512.86 / $2,951.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $676.08 / $831.76
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$154.88 / $162.18 / $190.55
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$478.63 / $512.86 / $645.65
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$169.82 / $169.82 / $169.82
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$588.84 / $588.84 / $588.84
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $616.60 / $758.58
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$95.50 / $128.82 / $147.91
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$316.23 / $467.74 / $660.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $660.69 / $891.25
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.28 / $138.04 / $199.53
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$295.12 / $537.03 / $691.83
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $831.76 / $831.76
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$169.82 / $199.53 / $199.53
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$537.03 / $630.96 / $630.96