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South Dakota rates for HCPCS 93923

Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental blood pressure measurements with bidirectional Doppler waveform recording and analysis, at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental volume plethysmography at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental transcutaneous oxygen tension measurements at 3 or more levels), or single level study with provocative functional maneuvers (eg, measurements with postural provocative tests, or measurements with reactive hyperemia)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.47 / $158.26 / $158.26
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$22.44 / $22.44 / $22.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.15 / $178.25 / $302.06
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.60 / $21.17 / $31.95
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$66.08 / $66.08 / $170.52
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$111.48 / $157.09 / $238.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.46 / $273.94 / $341.10
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.97 / $42.29 / $52.34
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$187.48 / $231.00 / $288.76
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.83 / $235.25 / $313.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.30 / $251.22 / $1,173.20
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$24.07 / $43.76 / $310.41
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$128.22 / $233.14 / $1,048.79
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$240.65 / $299.06 / $332.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.00 / $251.22 / $332.26
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.66 / $224.22 / $251.64
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$26.99 / $35.75 / $40.75
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$138.88 / $188.19 / $213.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.30 / $240.08 / $286.08
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$24.07 / $38.88 / $47.02
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$128.22 / $201.20 / $234.74
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.70 / $282.00 / $293.30
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.79 / $45.70 / $47.50
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$200.90 / $236.40 / $245.80