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South Dakota rates for HCPCS 74420

Urography, retrograde, with or without KUB

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$23.99 / $23.99 / $23.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $91.20 / $416.87
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$20.89 / $26.92 / $66.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $186.21 / $234.42
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.71 / $57.54 / $70.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $562.34 / $977.24
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.50 / $30.90 / $154.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $162.18 / $165.96
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.98 / $52.48 / $60.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $151.36 / $151.36
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.48 / $52.48 / $52.48
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $128.82 / $151.36
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.99 / $33.11 / $46.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $251.19 / $1,000.00
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$21.38 / $30.90 / $46.77
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $158.49 / $158.49
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.69 / $48.98 / $48.98