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South Dakota rates for HCPCS 74742

Transcervical catheterization of fallopian tube, radiological supervision and interpretation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.25 / $85.25 / $85.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.45 / $72.45 / $85.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.38 / $207.11 / $258.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.76 / $122.46 / $166.12
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.75 / $305.95 / $857.73
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.12 / $97.37 / $231.52
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.20 / $170.49 / $272.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.00 / $173.00 / $173.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.75 / $314.44 / $337.76
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.40 / $221.70 / $221.70