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South Dakota rates for HCPCS 76857

Us Pelvic Nonobstetric Image Dcmtn Limited/F/U

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$24.08 / $24.08 / $24.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.65 / $82.34 / $179.78
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$18.01 / $24.08 / $90.78
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$25.72 / $64.31 / $152.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.13 / $116.36 / $145.44
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$35.02 / $53.52 / $66.90
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$41.11 / $62.83 / $78.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.44 / $90.21 / $575.66
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$27.31 / $45.90 / $232.81
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$25.82 / $44.31 / $398.91
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$62.35 / $62.35 / $62.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.11 / $107.07 / $127.50
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.15 / $82.38 / $97.04
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$24.62 / $39.72 / $45.28
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$28.43 / $43.99 / $51.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.13 / $59.12 / $102.26
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.26 / $31.40 / $49.66
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$25.82 / $31.56 / $46.94
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.90 / $104.60 / $104.60
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.50 / $48.80 / $48.80
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$47.40 / $55.80 / $55.80