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South Dakota rates for HCPCS 75563

Cardiac Mri W/W/O Contrast W/Stress

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$142.13 / $142.13 / $142.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.61 / $397.61 / $465.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.98 / $1,001.43 / $1,251.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.75 / $929.24 / $4,924.22
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$482.91 / $482.91 / $482.91
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$908.73 / $1,130.48 / $1,346.31
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$604.48 / $784.84 / $859.86
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$179.90 / $236.04 / $269.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$522.08 / $929.24 / $1,110.07
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$950.60 / $1,118.40 / $1,118.40