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South Dakota rates for HCPCS G2004

Post-d/c h vst new pt 60 m

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.49 / $148.49 / $148.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.96 / $144.11 / $159.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.75 / $218.44 / $218.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.28 / $150.12 / $319.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.42 / $303.81 / $1,105.55
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.21 / $295.79 / $373.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.98 / $299.94 / $450.97
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.99 / $228.61 / $306.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.42 / $303.81 / $358.94
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.70 / $231.10 / $231.10