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South Dakota rates for HCPCS 76512

Ophthalmic Us Dx B-Scan W/Wo Non-Quan A-Scan

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.01 / $50.01 / $50.01
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$31.40 / $31.40 / $31.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.01 / $90.20 / $307.05
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$27.08 / $48.42 / $176.22
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$16.17 / $41.78 / $60.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.61 / $110.93 / $138.66
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.28 / $69.81 / $87.27
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$33.61 / $41.11 / $51.39
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.79 / $86.50 / $192.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.98 / $112.31 / $659.45
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.27 / $64.34 / $335.18
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$25.71 / $47.96 / $404.98
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.47 / $113.56 / $181.55
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$170.58 / $170.58 / $170.58
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.77 / $138.53 / $189.54
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.34 / $92.51 / $152.01
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.12 / $57.05 / $87.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$24.22 / $34.29 / $65.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.52 / $98.64 / $187.18
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$35.96 / $57.41 / $107.24
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$21.56 / $38.57 / $79.94
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.80 / $99.70 / $99.70
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.40 / $62.80 / $62.80
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$31.40 / $37.00 / $37.00