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South Dakota rates for HCPCS 77011

Computed tomography guidance for stereotactic localization

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$43.65 / $61.66 / $61.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $245.47 / $436.52
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.70 / $67.61 / $117.49
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$147.91 / $177.83 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $524.81 / $660.69
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$128.82 / $141.25 / $177.83
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$346.74 / $380.19 / $478.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $316.23 / $630.96
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$54.95 / $81.28 / $134.90
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$144.54 / $229.09 / $467.74
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $512.86 / $512.86
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$144.54 / $144.54 / $144.54
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$363.08 / $363.08 / $363.08
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $371.54 / $478.63
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$75.86 / $102.33 / $117.49
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$218.78 / $269.15 / $346.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $426.58 / $616.60
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$60.26 / $87.10 / $134.90
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$190.55 / $316.23 / $446.68
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $489.78 / $489.78
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$117.49 / $138.04 / $138.04
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$302.00 / $354.81 / $354.81