go back

South Dakota rates for HCPCS 73725

Mra Lower Extremity W/Wo Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$86.71 / $86.71 / $86.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.62 / $475.00 / $576.96
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$75.28 / $131.28 / $140.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$239.34 / $335.00 / $445.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$657.21 / $803.63 / $1,004.53
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$157.96 / $193.15 / $241.44
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$499.25 / $610.48 / $763.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.90 / $721.35 / $3,018.44
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.98 / $166.46 / $850.86
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$359.92 / $554.89 / $2,546.60
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$284.95 / $284.95 / $284.95
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$729.41 / $875.41 / $1,067.68
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$479.29 / $629.97 / $681.27
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$110.24 / $144.12 / $164.31
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$363.24 / $473.86 / $546.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$413.83 / $721.35 / $848.42
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.66 / $166.46 / $202.27
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$313.17 / $554.89 / $681.45
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
$189.10 / $222.50 / $222.50
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$574.00 / $675.20 / $675.20