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South Dakota rates for HCPCS G0454

Physician documentation of face-to-face visit for durable medical equipment determination performed by nurse practitioner, physician assistant or clinical nurse specialist

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.71 / $8.71 / $8.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.95 / $8.71 / $9.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.74 / $9.57 / $14.27
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.81 / $15.84 / $18.76
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.11 / $16.48 / $55.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.94 / $14.79 / $20.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.42 / $14.77 / $19.01
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.88 / $14.75 / $16.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.97 / $16.00 / $19.23
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.30 / $21.20 / $21.20