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South Dakota rates for HCPCS 75872

Venography, epidural, radiological supervision and interpretation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.31 / $135.31 / $135.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.13 / $115.13 / $135.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.87 / $299.42 / $374.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$164.90 / $202.26 / $711.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.29 / $262.52 / $3,555.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$252.17 / $298.91 / $434.74
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.26 / $323.61 / $652.83
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.45 / $236.01 / $272.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.79 / $255.44 / $326.76
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.20 / $257.89 / $257.89