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South Dakota rates for HCPCS 0258U

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,454.50 / $3,454.50 / $3,454.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,866.50 / $3,454.50 / $3,454.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,278.66 / $6,674.88 / $8,343.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,468.47 / $4,161.20 / $6,746.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,874.25 / $2,205.00 / $7,232.40
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,410.00 / $4,777.50 / $8,054.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,410.00 / $6,847.87 / $8,054.07
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,255.25 / $8,854.18 / $10,095.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,543.50 / $1,874.25 / $3,675.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,675.00 / $3,675.00 / $3,675.00