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South Dakota rates for HCPCS 74775

Perineogram

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$253.45 / $253.45 / $253.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.80 / $222.80 / $253.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.88 / $217.97 / $272.45
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.59 / $345.77 / $428.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.37 / $488.36 / $565.13
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.82 / $165.19 / $593.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.61 / $177.88 / $588.49
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.95 / $102.95 / $102.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.02 / $319.56 / $513.17
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$441.30 / $519.20 / $519.20