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South Dakota rates for HCPCS 95921

Testing of autonomic nervous system function; cardiovagal innervation (parasympathetic function), including 2 or more of the following: heart rate response to deep breathing with recorded R-R interval, Valsalva ratio, and 30:15 ratio

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$45.71 / $47.86 / $47.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $89.13 / $186.21
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.81 / $46.77 / $100.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$39.81 / $43.65 / $93.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $186.21 / $234.42
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.11 / $93.33 / $114.82
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$77.62 / $93.33 / $117.49
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $134.90 / $562.34
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.67 / $77.62 / $316.23
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$34.67 / $67.61 / $316.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $169.82 / $213.80
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$89.13 / $93.33 / $109.65
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$70.79 / $77.62 / $104.71
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $169.82 / $190.55
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$93.33 / $93.33 / $102.33
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$77.62 / $77.62 / $89.13
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $141.25 / $177.83
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $70.79 / $89.13
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$42.66 / $69.18 / $83.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $147.91 / $194.98
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.71 / $79.43 / $114.82
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$38.90 / $67.61 / $100.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $213.80 / $213.80
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$87.10 / $107.15 / $107.15
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$87.10 / $104.71 / $104.71