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South Dakota rates for HCPCS 78815

Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; skull base to mid-thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$115.23 / $115.23 / $115.23
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.30 / $169.00 / $307.05
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$209.98 / $256.76 / $320.95
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$131.36 / $221.20 / $284.70
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$127.90 / $191.21 / $218.01
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$133.02 / $186.42 / $238.84
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$213.70 / $251.40 / $251.40