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South Dakota rates for HCPCS 76775

Us Retroperitoneal Real Time W/Image Limited

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$27.81 / $27.81 / $27.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.47 / $112.65 / $167.84
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.92 / $39.18 / $117.48
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$32.15 / $85.82 / $162.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.37 / $141.18 / $176.47
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.11 / $62.83 / $78.54
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$51.26 / $78.34 / $97.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.91 / $109.15 / $562.97
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$31.66 / $53.48 / $186.58
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$32.92 / $55.67 / $399.92
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$92.57 / $92.57 / $92.57
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.77 / $131.38 / $155.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.33 / $99.82 / $117.74
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.75 / $46.33 / $53.05
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$35.89 / $54.99 / $64.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.54 / $106.20 / $169.48
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$31.66 / $44.99 / $57.56
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$32.92 / $39.51 / $59.86
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.90 / $126.90 / $126.90
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.60 / $57.20 / $57.20
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$59.30 / $69.80 / $69.80