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South Dakota rates for HCPCS 74221

Radiologic Exam Esophagus Double Contrast Study

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$33.78 / $33.78 / $33.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.72 / $107.06 / $181.31
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.94 / $51.21 / $90.90
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$69.79 / $81.98 / $533.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.44 / $253.65 / $317.07
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$61.53 / $75.23 / $94.05
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$145.91 / $178.41 / $223.01
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.12 / $202.61 / $730.62
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.86 / $64.81 / $210.44
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$88.02 / $137.79 / $520.19
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$102.26 / $102.26 / $102.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.07 / $242.38 / $279.83
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.02 / $183.84 / $212.99
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.45 / $56.17 / $64.04
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$97.56 / $127.67 / $150.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.85 / $174.32 / $228.80
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.14 / $54.54 / $69.76
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$88.88 / $108.29 / $148.13
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.00 / $217.60 / $217.60
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.50 / $66.50 / $66.50
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$128.50 / $151.10 / $151.10