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South Dakota rates for HCPCS 74240

Radiologic Exam Upr Gi Trc Single Contrast Study

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$39.04 / $39.04 / $39.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.54 / $112.29 / $202.59
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$31.76 / $59.15 / $153.97
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$77.06 / $80.54 / $143.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.55 / $283.13 / $353.91
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$71.05 / $86.88 / $108.60
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$160.50 / $196.25 / $245.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.96 / $223.81 / $812.81
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.59 / $72.65 / $240.49
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$94.06 / $149.13 / $572.32
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$110.06 / $110.06 / $110.06
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.00 / $257.60 / $312.26
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.87 / $188.18 / $234.18
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.82 / $58.99 / $73.75
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$93.96 / $129.19 / $160.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.65 / $179.95 / $226.08
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.13 / $62.74 / $74.67
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$94.06 / $125.40 / $164.59
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.70 / $243.20 / $243.20
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$65.09 / $76.59 / $76.59
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$141.60 / $166.60 / $166.60