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South Dakota rates for HCPCS 75574

Cta Hrt Cornry Art/Bypass Grfts Contrst 3d Post

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$115.25 / $115.25 / $115.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.17 / $372.31 / $548.44
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$106.09 / $111.49 / $307.05
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$162.97 / $266.22 / $373.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$628.66 / $768.72 / $960.90
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$209.98 / $256.76 / $320.95
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$403.72 / $511.96 / $639.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.42 / $671.27 / $2,091.94
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$142.44 / $219.87 / $711.82
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$292.80 / $451.40 / $1,773.11
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$366.11 / $366.11 / $366.11
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.36 / $711.65 / $903.15
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.58 / $604.77 / $692.54
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$144.16 / $192.19 / $218.01
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$312.05 / $397.65 / $488.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.46 / $671.27 / $846.92
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$133.41 / $219.87 / $249.27
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$262.04 / $451.40 / $614.19
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$631.50 / $742.90 / $742.90
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$216.30 / $254.40 / $254.40
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$415.20 / $488.50 / $488.50