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South Dakota rates for HCPCS 78472

Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without additional quantitative processing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$46.40 / $46.40 / $46.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.64 / $223.98 / $280.83
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$40.14 / $46.40 / $49.92
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$149.50 / $177.58 / $230.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.12 / $485.59 / $606.99
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$84.37 / $103.17 / $128.96
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$312.75 / $382.42 / $478.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.70 / $309.97 / $518.50
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.89 / $86.94 / $100.97
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$221.78 / $332.68 / $398.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$440.48 / $501.59 / $610.16
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.18 / $351.22 / $403.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$58.36 / $76.59 / $87.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$227.38 / $274.62 / $318.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.05 / $419.62 / $476.00
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.89 / $62.86 / $97.13
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$198.12 / $233.57 / $379.84
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.40 / $415.80 / $415.80
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.09 / $90.70 / $90.70
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$276.30 / $325.10 / $325.10