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South Dakota rates for HCPCS 74713

Fetal Mri W/Placntl Matrnl Plvc Img Ea Addl Ges

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$217.34 / $217.34 / $217.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.53 / $185.53 / $217.34
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
$385.07 / $470.85 / $588.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$265.73 / $360.51 / $626.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.02 / $427.09 / $1,349.26
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$401.95 / $478.16 / $684.95
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.54 / $523.98 / $608.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.95 / $343.28 / $394.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.46 / $427.09 / $498.21
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.40 / $529.90 / $529.90