go back

South Dakota rates for HCPCS 99254

Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.

Facilitymedian $141 · 10th–90th $112–$2290%20%10th90th$141Professionalmedian $178 · 10th–90th $117–$4270%10%10th90th$178$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $128.82 / $151.36
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $169.82 / $426.58
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $346.74 / $398.11
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $223.87 / $302.00
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $239.88 / $1,000.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $251.19 / $275.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $275.42 / $331.13
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $194.98 / $199.53