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South Dakota rates for HCPCS 75557

Cardiac magnetic resonance imaging for morphology and function without contrast material;

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$112.20 / $112.20 / $112.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $426.58 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $676.08 / $851.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $549.54 / $812.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $602.56 / $724.44
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$218.78 / $234.42 / $269.15
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $524.81 / $630.96
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$134.90 / $186.21 / $213.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $575.44 / $794.33
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $741.31 / $741.31