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South Dakota rates for HCPCS 77058

Mri Breast Unilateral

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $1,513.56 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,230.27 / $1,513.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,801.89 / $3,801.89 / $3,801.89
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $954.99 / $1,122.02