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South Dakota rates for HCPCS 93922

Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, Doppler waveform recording and analysis at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with, transcutaneous oxygen tension measurement at 1-2 levels)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$12.46 / $12.46 / $12.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.63 / $115.56 / $197.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$10.85 / $11.55 / $77.43
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$41.82 / $41.82 / $145.60
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$72.26 / $104.06 / $197.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.90 / $174.11 / $215.48
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$18.69 / $23.36 / $28.79
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$121.21 / $150.84 / $186.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.13 / $162.12 / $768.54
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$13.50 / $24.54 / $267.48
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$84.63 / $153.88 / $698.48
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.00 / $162.12 / $214.62
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.05 / $139.01 / $158.49
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$15.01 / $19.86 / $22.82
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$83.30 / $119.15 / $135.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.13 / $154.26 / $229.64
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$12.82 / $21.97 / $25.85
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$84.63 / $132.10 / $198.88
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.00 / $177.60 / $184.70
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$21.60 / $25.40 / $26.40
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$129.40 / $152.30 / $158.30