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South Dakota rates for HCPCS 73723

Mri Any Jt Lower Extrem W/O & W/Contrast Matrl

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 / $426.37 / $598.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$96.66 / $233.10 / $281.24
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$271.38 / $335.00 / $462.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$748.56 / $915.33 / $1,144.16
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
$558.88 / $683.39 / $854.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$547.00 / $843.29 / $5,981.06
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$129.08 / $199.18 / $883.52
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$417.80 / $644.11 / $5,438.76
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$340.60 / $340.60 / $340.60
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$830.46 / $1,022.32 / $1,436.46
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$554.22 / $717.24 / $866.61
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$131.72 / $173.06 / $197.30
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$415.32 / $529.79 / $676.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.34 / $820.49 / $994.48
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$118.33 / $193.79 / $261.85
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$354.70 / $626.70 / $791.10
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$868.70 / $1,022.10 / $1,022.10
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
$641.70 / $754.90 / $754.90