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South Dakota rates for HCPCS 78215

Liver and spleen imaging; static only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$23.38 / $23.38 / $23.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.27 / $196.00 / $307.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$347.00 / $424.31 / $530.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.15 / $263.73 / $439.14
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.00 / $388.23 / $524.55
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.34 / $305.83 / $349.91
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$29.17 / $38.58 / $43.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.10 / $243.06 / $405.10
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.70 / $362.00 / $362.00