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South Dakota rates for HCPCS G2025

Payment for a telehealth distant site service furnished by a Rural Health Clinic (RHC) or Federally Qualified Health Center (FQHC) only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.86 / $96.86 / $98.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.03 / $94.81 / $96.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.93 / $109.50 / $136.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.86 / $160.22 / $221.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.05 / $151.88 / $599.65
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.53 / $159.83 / $227.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.05 / $140.26 / $172.54
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.27 / $165.68 / $188.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.83 / $145.31 / $175.01
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.19 / $142.30 / $142.30