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South Dakota rates for HCPCS 77063

Screening Digital Breast Tomosynthesis Bi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$29.22 / $29.22 / $29.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.14 / $58.31 / $130.83
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$26.89 / $43.55 / $76.54
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$34.27 / $36.90 / $60.30
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$23.58 / $36.86 / $65.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.60 / $121.78 / $152.22
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.29 / $65.16 / $81.45
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$46.31 / $56.63 / $70.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.30 / $102.21 / $334.42
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$36.82 / $55.48 / $84.81
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$29.85 / $46.73 / $151.88
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$102.21 / $102.21 / $102.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.27 / $124.25 / $144.12
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.36 / $89.69 / $101.56
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$36.47 / $48.62 / $54.99
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$30.58 / $40.85 / $46.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.32 / $99.45 / $111.38
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.56 / $53.98 / $63.44
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$28.65 / $36.74 / $50.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $113.80 / $113.80
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.40 / $61.60 / $61.60
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$44.40 / $52.20 / $52.20