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South Dakota rates for HCPCS 95810

Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$128.61 / $128.61 / $128.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$636.75 / $720.28 / $1,077.18
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$111.15 / $132.19 / $463.37
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$285.27 / $318.38 / $343.82
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$519.69 / $602.07 / $913.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,306.91 / $1,309.57 / $1,636.96
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$235.44 / $237.79 / $294.89
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,071.47 / $1,073.66 / $1,342.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$626.94 / $1,161.23 / $6,200.00
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$133.97 / $243.58 / $2,600.00
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$505.15 / $1,010.30 / $7,000.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$982.52 / $1,218.94 / $1,543.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$738.06 / $1,004.92 / $1,216.82
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$139.76 / $196.89 / $224.47
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$596.95 / $807.25 / $992.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$689.63 / $1,109.77 / $1,304.54
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$133.97 / $214.81 / $257.17
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$505.15 / $881.93 / $1,162.45
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,255.09 / $1,535.60 / $1,535.60
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$231.50 / $283.30 / $283.30
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,023.60 / $1,252.40 / $1,252.40