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South Dakota rates for HCPCS 77054

Mammary Ductogram Or Galactogram Multiple

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.59 / $72.59 / $72.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.44 / $62.44 / $72.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.22 / $162.90 / $203.62
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.20 / $105.52 / $171.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.82 / $136.94 / $678.50
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.65 / $158.68 / $235.48
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.02 / $167.12 / $235.48
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.68 / $121.23 / $134.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.09 / $132.13 / $155.46
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.19 / $150.80 / $150.80