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South Dakota rates for HCPCS 74400

Urography (pyelography), intravenous, with or without KUB, with or without tomography

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$22.91 / $22.91 / $22.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $141.25 / $199.53
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.95 / $22.91 / $69.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $316.23 / $398.11
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.66 / $53.70 / $66.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $165.96 / $316.23
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$24.55 / $38.02 / $186.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $263.03 / $281.84
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.77 / $47.86 / $57.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $263.03 / $263.03
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.12 / $50.12 / $50.12
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $186.21 / $257.04
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.18 / $38.02 / $43.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $190.55 / $275.42
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$24.55 / $40.74 / $53.70
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $269.15 / $269.15
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.90 / $45.71 / $45.71