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South Dakota rates for HCPCS 76391

Magnetic resonance (eg, vibration) elastography

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$53.30 / $53.30 / $53.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.31 / $186.31 / $222.47
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.83 / $53.30 / $177.30
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$140.47 / $140.47 / $169.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.51 / $476.28 / $595.35
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$97.06 / $118.68 / $148.35
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$292.45 / $357.60 / $447.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.58 / $434.12 / $1,374.92
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.48 / $103.38 / $330.16
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$214.53 / $330.74 / $1,044.76
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$165.44 / $165.44 / $165.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.95 / $525.41 / $643.73
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.72 / $344.41 / $401.26
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.94 / $87.95 / $100.27
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$183.08 / $256.45 / $302.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.66 / $356.25 / $498.75
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$61.92 / $103.38 / $119.39
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$185.74 / $330.74 / $397.73
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$451.90 / $531.60 / $531.60
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$115.40 / $135.69 / $135.69
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$336.50 / $395.90 / $395.90