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South Dakota rates for HCPCS 74248

Radiologic Small Intestine Follow-Through 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
$73.88 / $80.50 / $134.96
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.94 / $51.21 / $105.02
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$44.95 / $47.97 / $83.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.41 / $190.05 / $237.56
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
$93.89 / $114.80 / $143.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.26 / $153.62 / $546.16
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
$56.70 / $88.80 / $335.78
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
$169.13 / $185.08 / $214.50
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.26 / $138.44 / $159.11
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
$62.81 / $82.27 / $96.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.66 / $132.18 / $165.22
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.14 / $55.81 / $69.76
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$57.27 / $81.14 / $95.46
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.30 / $163.90 / $163.90
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
$82.80 / $97.40 / $97.40