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South Dakota rates for HCPCS 74712

Magnetic resonance (eg, proton) imaging, fetal, including placental and maternal pelvic imaging when performed; single or first gestation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.74 / $389.74 / $389.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.18 / $344.18 / $522.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,520.00 / $1,520.00 / $1,520.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.87 / $971.95 / $1,214.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.34 / $613.10 / $853.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$572.75 / $882.99 / $2,369.29
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.16 / $742.98 / $1,329.12
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$564.99 / $847.11 / $1,108.99
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$556.39 / $705.28 / $812.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$503.30 / $859.12 / $1,016.02
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$925.30 / $1,088.59 / $1,088.59