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South Dakota rates for HCPCS 75774

Angrph Slctv Ea Vsl Studied After Basic Xm Rs&I

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$46.12 / $46.12 / $46.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.86 / $163.13 / $234.33
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.71 / $24.17 / $199.80
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$46.16 / $146.43 / $212.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.80 / $221.07 / $276.33
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.98 / $102.39 / $127.99
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$97.06 / $118.68 / $148.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.04 / $182.07 / $2,899.89
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$20.75 / $55.85 / $425.60
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$71.62 / $110.41 / $2,808.09
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$56.60 / $56.60 / $56.60
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.68 / $202.36 / $484.37
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.97 / $157.82 / $185.66
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$21.88 / $65.59 / $87.98
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$72.83 / $97.62 / $129.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.00 / $161.22 / $198.75
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.94 / $54.32 / $88.34
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$61.12 / $104.11 / $145.76
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.90 / $192.80 / $192.80
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.59 / $91.40 / $91.40
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$86.20 / $101.40 / $101.40