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South Dakota rates for HCPCS 78830

Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT) with concurrently acquired computed tomography (CT) transmission scan for anatomical review, localization and determination/detection of pathology, single area (eg, head, neck, chest, pelvis) or acquisition, single day imaging

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$67.61 / $67.61 / $67.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $512.86 / $1,096.48
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.10 / $89.13 / $213.80
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$380.19 / $436.52 / $933.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,023.29 / $1,288.25
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$125.89 / $154.88 / $194.98
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$707.95 / $870.96 / $1,096.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $660.69 / $1,412.54
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.10 / $93.33 / $199.53
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$371.54 / $562.34 / $1,230.27
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,659.59 / $1,659.59
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$251.19 / $251.19 / $251.19
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,412.54 / $1,412.54 / $1,412.54
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $724.44 / $912.01
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$91.20 / $128.82 / $128.82
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$512.86 / $691.83 / $691.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $741.31 / $1,047.13
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$79.43 / $112.20 / $151.36
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$446.68 / $630.96 / $912.01
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $851.14 / $851.14
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$114.82 / $134.90 / $134.90
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$616.60 / $724.44 / $724.44