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South Dakota rates for HCPCS 77047

Mri Breast Without Contrast Material Bilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$77.39 / $77.39 / $77.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.60 / $371.25 / $522.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.36 / $116.83 / $154.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$136.24 / $254.41 / $368.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.67 / $520.49 / $650.62
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$140.19 / $171.43 / $214.29
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$285.47 / $349.07 / $436.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.61 / $596.79 / $1,484.56
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$96.12 / $148.19 / $478.82
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$208.31 / $553.04 / $1,005.68
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$238.72 / $238.72 / $238.72
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$473.22 / $570.73 / $698.97
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.16 / $377.32 / $435.49
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$82.17 / $127.67 / $145.55
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$177.67 / $249.66 / $292.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.63 / $468.90 / $1,085.08
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$89.47 / $148.19 / $175.96
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$180.16 / $320.70 / $943.42
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$495.00 / $582.40 / $582.40
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$167.50 / $197.10 / $197.10
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$327.50 / $385.40 / $385.40