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South Dakota rates for HCPCS 95875

Ischemic limb exercise test with serial specimen(s) acquisition for muscle(s) metabolite(s)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.22 / $152.90 / $176.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.82 / $252.64 / $315.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.63 / $243.09 / $880.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.44 / $253.51 / $294.69
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.26 / $197.74 / $232.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.38 / $241.06 / $283.61
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.20 / $293.89 / $293.89