go back

South Dakota rates for HCPCS 74246

Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed; double-contrast (eg, high-density barium and effervescent agent) study, including glucagon, when administered

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$43.25 / $43.25 / $43.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.45 / $125.19 / $229.07
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$31.76 / $102.35 / $117.48
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$87.96 / $89.70 / $163.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.00 / $320.36 / $400.46
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.58 / $96.19 / $120.23
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$183.33 / $224.18 / $280.22
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.88 / $254.80 / $927.52
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.59 / $72.79 / $268.38
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$111.29 / $174.51 / $659.08
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$109.76 / $109.76 / $109.76
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.00 / $291.06 / $368.51
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.03 / $211.77 / $264.58
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.70 / $60.77 / $81.51
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$110.70 / $152.19 / $183.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.97 / $254.80 / $301.83
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.34 / $69.31 / $83.34
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$111.29 / $142.28 / $185.48
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.50 / $274.70 / $274.70
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$71.90 / $84.60 / $84.60
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$161.60 / $190.10 / $190.10