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South Dakota rates for HCPCS 74021

Radiologic examination, abdomen; 3 or more views

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$12.88 / $12.88 / $12.88
Aetna
Facility/Professional
Facility
Modifier
TC
Low / Median / High Price
$32.36 / $46.77 / $295.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $44.67 / $123.03
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$12.02 / $16.98 / $32.36
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$26.92 / $32.36 / $46.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $102.33 / $125.89
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.44 / $29.51 / $36.31
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$57.54 / $72.44 / $91.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $58.88 / $97.72
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$13.49 / $20.89 / $38.02
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$25.12 / $38.02 / $72.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $89.13 / $91.20
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.70 / $26.92 / $31.62
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$57.54 / $58.88 / $64.57
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $85.11
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$27.54 / $27.54 / $27.54
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$57.54 / $57.54 / $57.54
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $70.79 / $83.18
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$15.49 / $21.38 / $24.55
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$35.48 / $51.29 / $58.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $61.66 / $95.50
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$14.79 / $21.88 / $29.51
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$28.18 / $40.74 / $64.57
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $85.11 / $85.11
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$21.88 / $25.70 / $25.70
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$51.29 / $60.26 / $60.26