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South Dakota rates for HCPCS 76816

Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan), transabdominal approach, per fetus

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$40.74 / $40.74 / $40.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $199.53 / $323.59
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.90 / $85.11 / $173.78
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$64.57 / $125.89 / $323.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $263.03 / $323.59
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$75.86 / $95.50 / $120.23
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$131.83 / $165.96 / $208.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $204.17 / $707.95
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.65 / $83.18 / $257.04
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$74.13 / $141.25 / $446.68
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $257.04 / $257.04
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.28 / $100.00 / $100.00
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$134.90 / $154.88 / $154.88
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $177.83 / $208.93
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$47.86 / $67.61 / $77.62
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$83.18 / $117.49 / $131.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $173.78 / $257.04
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.66 / $66.07 / $100.00
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$72.44 / $104.71 / $158.49
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $229.09 / $229.09
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.79 / $83.18 / $83.18
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$120.23 / $144.54 / $144.54