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South Dakota rates for HCPCS 78580

Pulmonary Perfusion Imaging Particulate

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$35.18 / $35.18 / $35.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.40 / $237.41 / $314.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.44 / $501.88 / $627.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.68 / $324.64 / $539.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.00 / $475.72 / $633.86
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.57 / $362.57 / $419.64
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.20 / $58.44 / $66.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.64 / $324.64 / $498.68
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.80 / $429.20 / $429.20