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South Dakota rates for HCPCS A2004

Misc W/Motor Score 12-32

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.60 / $15.60 / $15.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.26 / $15.60 / $15.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.26 / $13.26 / $215.43
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.60 / $21.89 / $28.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.00 / $13.00 / $1,391.41
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.43 / $340.91 / $659.61
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $215.43 / $659.61
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.26 / $13.26 / $13.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.00 / $13.00 / $14.30
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.00 / $13.00 / $13.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.00 / $13.00 / $13.00