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South Dakota rates for HCPCS 78456

Acute venous thrombosis imaging, peptide

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.83 / $306.83 / $306.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.33 / $306.83 / $306.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$542.39 / $663.22 / $829.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$327.60 / $439.97 / $713.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.08 / $434.07 / $701.53
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$532.41 / $688.14 / $1,069.05
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.67 / $632.19 / $839.66
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.92 / $478.32 / $551.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.53 / $465.28 / $666.92
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$481.30 / $566.20 / $566.20