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South Dakota rates for HCPCS 75557

Cardiac Mri Morphology & Function W/O Contrast

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$112.68 / $112.68 / $112.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.49 / $331.76 / $475.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$538.58 / $658.57 / $823.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.20 / $597.35 / $3,148.28
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$371.99 / $371.99 / $371.99
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.19 / $722.35 / $897.97
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.72 / $516.46 / $550.86
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$142.02 / $186.11 / $212.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.73 / $581.20 / $675.84
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$626.79 / $737.40 / $737.40