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South Dakota rates for HCPCS 77058

Magnetic Resonance Imaging Breast

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,520.00 / $1,520.00 / $1,520.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.57 / $1,195.34 / $1,494.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,772.97 / $3,772.97 / $3,772.97
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$961.55 / $961.55 / $1,470.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.55 / $1,085.81 / $1,344.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$651.30 / $880.74 / $1,074.56