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South Dakota rates for HCPCS 75561

Cardiac Mri W/Wo Contrast & Further Seq

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$124.72 / $124.72 / $124.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.65 / $475.00 / $612.66
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$124.72 / $253.40 / $543.79
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$232.18 / $335.00 / $423.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$702.25 / $858.70 / $1,073.36
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$227.11 / $277.70 / $347.13
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$475.15 / $581.00 / $726.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.88 / $784.53 / $3,919.13
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$153.88 / $237.23 / $771.93
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$355.00 / $547.29 / $3,292.02
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$411.71 / $411.71 / $411.71
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$780.65 / $953.12 / $1,241.94
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$510.58 / $674.22 / $721.56
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$157.03 / $206.53 / $235.47
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$353.53 / $450.50 / $502.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.78 / $784.53 / $930.24
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$144.19 / $230.82 / $274.80
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$303.58 / $547.03 / $628.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$816.60 / $960.80 / $960.80
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$271.00 / $318.80 / $318.80
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$545.70 / $642.00 / $642.00