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South Dakota rates for HCPCS 74177

Computed tomography, abdomen and pelvis; with contrast material(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$88.14 / $88.14 / $88.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.95 / $352.69 / $1,872.72
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$80.95 / $87.23 / $245.34
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$218.69 / $382.43 / $4,137.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$589.33 / $720.63 / $900.78
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$160.50 / $196.25 / $245.32
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$428.84 / $524.37 / $655.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.38 / $610.28 / $2,077.84
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$109.71 / $178.84 / $423.90
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$266.31 / $441.15 / $2,614.00
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$283.05 / $283.05 / $283.05
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$598.33 / $711.03 / $865.91
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.00 / $507.09 / $603.47
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$111.97 / $148.54 / $166.90
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$266.58 / $363.48 / $433.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.09 / $593.78 / $672.34
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$101.86 / $169.13 / $195.56
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$271.23 / $441.15 / $493.67
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$589.79 / $693.80 / $693.80
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$165.60 / $194.80 / $194.80
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$424.20 / $499.10 / $499.10