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South Dakota rates for HCPCS 74290

Cholecystography Oral Contrst

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.25 / $92.25 / $92.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.68 / $76.68 / $92.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.50 / $196.25 / $245.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.03 / $128.40 / $155.90
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.49 / $147.86 / $572.92
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.96 / $168.97 / $283.05
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.00 / $168.97 / $218.58
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.27 / $120.58 / $161.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.74 / $140.82 / $153.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.69 / $167.90 / $167.90