go back

South Dakota rates for HCPCS 91200

Liver Elastography W/O Imag W/I&R

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$11.37 / $11.37 / $11.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.41 / $50.68 / $100.80
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$10.42 / $13.91 / $36.90
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$20.70 / $23.74 / $63.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.10 / $63.72 / $78.51
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$17.29 / $21.24 / $26.17
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$33.97 / $42.48 / $52.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.55 / $77.36 / $195.66
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.54 / $27.56 / $69.84
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$29.88 / $48.78 / $129.61
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.57 / $74.04 / $80.69
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.58 / $55.93 / $59.58
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$14.21 / $19.05 / $23.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$25.74 / $34.81 / $38.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $66.83 / $78.62
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$14.14 / $24.80 / $29.84
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$27.39 / $48.78 / $49.80
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.40 / $67.50 / $70.20
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.50 / $23.00 / $23.90
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$37.79 / $44.50 / $46.30