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South Dakota rates for HCPCS 76497

Unlisted computed tomography procedure (eg, diagnostic, interventional)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $114.82 / $1,819.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $123.03 / $213.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $407.38 / $501.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $169.82 / $208.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $234.42 / $660.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $234.42 / $234.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $218.78 / $218.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $109.65 / $138.04