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South Dakota rates for HCPCS 76812

Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; each additional gestation (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$87.13 / $87.13 / $87.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.56 / $160.11 / $275.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.80 / $444.48 / $555.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.46 / $371.18 / $1,243.70
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$283.42 / $283.42 / $283.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.00 / $424.07 / $487.60
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.94 / $321.72 / $366.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$105.10 / $142.41 / $162.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.54 / $248.38 / $413.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.20 / $395.50 / $395.50