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South Dakota rates for HCPCS 77046

Mri Breast Without Contrast Material Unilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$69.90 / $69.90 / $69.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.03 / $197.03 / $522.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$412.98 / $504.98 / $631.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.41 / $600.74 / $1,445.91
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$215.66 / $215.66 / $215.66
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$458.99 / $555.24 / $674.95
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$287.74 / $365.97 / $420.28
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.23 / $115.18 / $131.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.04 / $456.89 / $1,092.26
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.20 / $564.90 / $564.90