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South Dakota rates for HCPCS 95958

Wada activation test for hemispheric function, including electroencephalographic (EEG) monitoring

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$750.47 / $750.47 / $750.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$554.90 / $750.47 / $862.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,218.33 / $1,501.18 / $1,876.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$428.00 / $714.42 / $1,412.49
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$582.27 / $1,096.88 / $4,008.69
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$852.35 / $1,303.04 / $1,694.94
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$678.63 / $1,096.88 / $1,344.46
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$678.42 / $950.95 / $1,376.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$582.27 / $1,049.06 / $1,398.74
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,419.90 / $1,737.30 / $1,737.30