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South Dakota rates for HCPCS 75635

Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$113.94 / $113.94 / $113.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.49 / $461.44 / $507.59
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$105.44 / $172.62 / $304.38
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$163.27 / $350.63 / $364.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$641.48 / $980.48 / $1,225.60
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$207.44 / $253.65 / $317.07
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$475.53 / $726.83 / $908.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.83 / $766.38 / $4,801.00
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$142.07 / $219.02 / $1,632.94
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$317.05 / $554.84 / $3,601.00
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$376.67 / $376.67 / $376.67
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.36 / $711.42 / $1,150.68
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.26 / $687.92 / $809.27
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$137.87 / $189.51 / $216.06
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$318.54 / $504.26 / $593.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$504.90 / $766.38 / $922.94
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$132.61 / $213.11 / $249.86
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$372.29 / $528.41 / $608.98
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$802.80 / $944.50 / $944.50
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$214.30 / $252.20 / $252.20
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$588.50 / $692.30 / $692.30