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South Dakota rates for HCPCS 75625

Aortography, abdominal, by serialography, radiological supervision and interpretation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$64.87 / $64.87 / $64.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.69 / $216.53 / $306.79
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.85 / $58.13 / $216.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$54.34 / $163.68 / $237.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.55 / $283.13 / $353.91
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$117.99 / $144.28 / $180.35
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$113.55 / $138.85 / $173.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.44 / $253.71 / $3,098.01
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$65.09 / $113.90 / $636.41
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$83.32 / $128.44 / $2,808.09
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$181.32 / $181.32 / $181.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.52 / $292.67 / $606.28
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.10 / $224.22 / $243.23
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$68.47 / $96.46 / $129.38
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$84.88 / $113.85 / $156.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.38 / $217.94 / $286.04
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$79.09 / $108.48 / $125.26
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$71.90 / $124.97 / $172.14
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.70 / $252.60 / $252.60
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$114.20 / $134.30 / $134.30
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$100.50 / $118.20 / $118.20