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South Dakota rates for HCPCS G0219

PET imaging whole body; melanoma for noncovered indications

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.16 / $199.16 / $199.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.16 / $199.16 / $1,300.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,088.63 / $1,088.63 / $1,360.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$284.80 / $2,197.00 / $3,562.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,464.44 / $2,464.44 / $2,464.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.50 / $100.50 / $100.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.31 / $96.31 / $96.31
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.96 / $574.96 / $574.96