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South Dakota rates for HCPCS 78491

Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); single study, at rest or stress (exercise or pharmacologic)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,580.45 / $1,580.45 / $1,580.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,300.00 / $1,580.45 / $1,580.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,516.57 / $3,077.20 / $3,846.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$384.92 / $2,187.90 / $3,562.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$882.14 / $1,820.30 / $2,924.78
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.58 / $1,268.64 / $1,370.71
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.15 / $1,178.47 / $3,542.07
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.85 / $125.85 / $125.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,532.03 / $1,902.59 / $2,806.30
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,930.20 / $3,447.30 / $3,447.30