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South Dakota rates for HCPCS 78496

Cardiac blood pool imaging, gated equilibrium, single study, at rest, with right ventricular ejection fraction by first pass technique (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.61 / $43.40 / $43.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.03 / $95.41 / $119.26
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.71 / $78.68 / $126.81
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.45 / $100.04 / $262.68
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.70 / $72.93 / $87.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.42 / $66.09 / $94.35
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.80 / $83.30 / $83.30