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South Dakota rates for HCPCS 74455

Urethrocystography Voiding Rs&I

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.33 / $111.33 / $476.30
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$15.90 / $15.90 / $15.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.35 / $94.14 / $173.18
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$13.75 / $23.96 / $57.60
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$76.31 / $80.39 / $149.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.39 / $238.92 / $298.64
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.55 / $34.90 / $43.63
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$162.02 / $204.01 / $255.01
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.62 / $159.10 / $188.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.70 / $172.73 / $687.89
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.64 / $30.29 / $150.00
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$78.98 / $138.22 / $591.79
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$156.19 / $202.16 / $344.16
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$52.11 / $52.11 / $52.11
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.00 / $200.30 / $263.02
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.48 / $146.62 / $196.66
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.73 / $26.10 / $29.76
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$79.25 / $124.43 / $166.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $144.82 / $182.10
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$18.37 / $26.29 / $33.29
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$94.75 / $131.63 / $157.82
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.60 / $204.20 / $204.20
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$26.30 / $30.90 / $30.90
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$147.30 / $173.30 / $173.30