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South Dakota rates for HCPCS 90969

End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients 12-19 years of age

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.15 / $18.23 / $18.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.60 / $30.69 / $42.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.86 / $28.26 / $39.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.00 / $25.50 / $124.43
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.87 / $34.68 / $41.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.65 / $30.26 / $38.13
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.52 / $24.95 / $32.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.48 / $24.51 / $33.28
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.80 / $37.70 / $37.70