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South Dakota rates for HCPCS C8903

Magnetic Resonance Imaging With Contrast Breast; Unilateral (Special Coverage Instructions Apply)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.75 / $318.75 / $318.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.07 / $237.07 / $318.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,520.00 / $1,520.00 / $1,520.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.65 / $538.69 / $715.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.07 / $169.24 / $485.84