Commercial healthcare reimbursement in South Dakota
How South Dakota compares with the nation, by payer, specialty and procedure.
South Dakota at a glance
What the data shows
South Dakota ranks 6th of 51 states for commercial reimbursement, with an index of 135 (100 = national median) across 228 procedure codes; the Midwest region averages 115.
Commercial rates in South Dakota run a median 202% of Medicare.
UnitedHealthcare has the highest index in the state (104) and Aetna the lowest (51), a 53-point gap, in the files analyzed.
CPT 77280 (Ther rad simulaj field smpl) is the strongest relative to the national median (198% of it, a 98% premium); CPT 52000 (Cystourethroscopy) is furthest below (90% of the national median, 10% lower).
By specialty, South Dakota is strongest for orthopedic surgery (ranks 4th of 51 states for that specialty) and weakest for gastroenterology (16th of 50).
Against Medicare, gastroenterology has the highest ratio in South Dakota (227% of Medicare) and internal medicine the lowest (150%).
Payer ranking in South Dakota
| Payer | Index | Rank | Level | Codes | Providers | TINs |
|---|---|---|---|---|---|---|
| UnitedHealthcare | 104 | 1 | 228 | 316 | 170 | |
| Cigna | 103 | 2 | 204 | 286 | 143 | |
| Blue Cross Blue Shield | 100 | 3 | 228 | 457 | 211 | |
| Aetna | 51 | 4 | 70 | 147 | 127 |
Reimbursement index by specialty in South Dakota
| Specialty | Index | Rank among states | % of Medicare | Level | Codes | Providers |
|---|---|---|---|---|---|---|
| Orthopedic surgery | 138 | 4 of 51 | 201% | 39 | 97 | |
| Diagnostic radiology | 128 | 4 of 51 | 201% | 49 | 85 | |
| Ophthalmology | 153 | 5 of 50 | 201% | 42 | 39 | |
| Dermatology | 157 | 5 of 50 | 160% | 44 | 37 | |
| Cardiology | 125 | 12 of 51 | 192% | 38 | 34 | |
| Urology | 116 | 12 of 50 | 216% | 37 | 34 | |
| Internal medicine | 116 | 14 of 51 | 150% | 25 | 123 | |
| Gastroenterology | 110 | 16 of 50 | 227% | 36 | 25 |
Specialty by payer in South Dakota
| Specialty | UHC | Aetna | Cigna | BCBS |
|---|---|---|---|---|
| Internal medicine | 139 | 72 | 124 | 107 |
| Dermatology | 189 | n/a | 156 | 134 |
| Ophthalmology | 174 | n/a | 169 | 155 |
| Cardiology | 127 | n/a | 125 | 129 |
| Orthopedic surgery | 147 | 123 | 138 | 137 |
| Diagnostic radiology | 135 | 62 | 140 | 127 |
| Urology | 138 | n/a | 123 | 112 |
| Gastroenterology | 139 | n/a | n/a | 122 |
South Dakota compared with Midwest region states
| State | Index | Rank | % of Medicare | Providers | Level |
|---|---|---|---|---|---|
| South Dakota | 135 | 6 | 202% | 474 | |
| Nebraska | 138 | 4 | 198% | 601 | |
| Iowa | 128 | 8 | 195% | 716 | |
| North Dakota | 127 | 9 | 197% | 369 | |
| Minnesota | 126 | 10 | 167% | 853 | |
| Wisconsin | 159 | 2 | 225% | 869 |
Procedures that pay most and least in South Dakota vs the nation
Highest vs national
| Code | South Dakota | National | Gap | Prov. |
|---|---|---|---|---|
| 77280 Ther rad simulaj field smpl | $597 | $302 | +98% | 37 |
| 88342 Imhchem/imcytchm 1st antb | $184 | $95 | +93% | 37 |
| 65820 Goniotomy | $1,754 | $955 | +84% | 39 |
| 92025 Cptrized corneal topography | $73 | $40 | +81% | 39 |
| 92273 Full field erg w/i&r | $255 | $142 | +79% | 39 |
| 66821 After cataract laser surgery | $700 | $393 | +78% | 39 |
| 65756 Corneal trnspl endothelial | $2,532 | $1,425 | +78% | 39 |
| 88312 Special stains group 1 | $173 | $97 | +77% | 62 |
| 66991 Xcapsl ctrc rmvl insj 1+ | $1,486 | $840 | +77% | 39 |
| 88313 Special stains group 2 | $124 | $71 | +75% | 25 |
| 14040 Tis trnfr f/c/c/m/n/a/g/h/f | $1,388 | $800 | +73% | 37 |
| 67036 Removal of inner eye fluid | $1,931 | $1,117 | +73% | 39 |
| 15823 Blepharp upr eyelid xcsv skn | $1,169 | $677 | +73% | 39 |
| 88305 Tissue exam by pathologist | $121 | $70 | +72% | 62 |
| 14301 Tis trnfr any 30.1-60 sq cm | $1,968 | $1,155 | +70% | 37 |
Lowest vs national
| Code | South Dakota | National | Gap | Prov. |
|---|---|---|---|---|
| 52000 Cystourethroscopy | $190 | $210 | -10% | 33 |
| 43239 Egd biopsy single/multiple | $316 | $349 | -10% | 25 |
| 51700 Irrigation of bladder | $71 | $77 | -8% | 33 |
| 51720 Treatment of bladder lesion | $103 | $111 | -7% | 33 |
| 43235 Egd diagnostic brush wash | $282 | $294 | -4% | 25 |
| 45380 Colonoscopy and biopsy | $455 | $470 | -3% | 25 |
| 51702 Insert temp bladder cath | $60 | $61 | -2% | 33 |
| 43255 Egd control bleeding any | $452 | $459 | -1% | 25 |
| 99495 Transj care mgmt mod f2f 14d | $211 | $211 | -0% | 123 |
| 45384 Colonoscopy w/lesion removal | $519 | $519 | +0% | 25 |
| 52332 Cystoscopy and treatment | $364 | $360 | +1% | 33 |
| 64566 Neuroeltrd stim post tibial | $71 | $69 | +2% | 33 |
| 45378 Diagnostic colonoscopy | $420 | $408 | +3% | 25 |
| 70551 Mri brain stem w/o dye | $415 | $402 | +3% | 85 |
| 72141 Mri neck spine w/o dye | $404 | $390 | +4% | 85 |
Frequently asked questions
How do commercial reimbursement rates in South Dakota compare with the rest of the country?
South Dakota ranks 6th of 51 states with an index of 135, across 228 procedure codes. Median commercial rates run 202% of the Medicare rate.
Which payer has the highest rates in South Dakota?
In the files we analyzed, UnitedHealthcare has the highest index (104) and Aetna the lowest (51). Each payer's figures describe the specific plans and networks in the files used, not its whole book of business.
Which specialty has the strongest rates in South Dakota?
Orthopedic surgery ranks 4th of 51 states.
How many providers does this South Dakota page cover?
474 sampled providers across 4 payers. The data comes from a random sample of providers, so counts describe the sample, not every provider in the state.
Which procedures differ most between South Dakota and the national median?
CPT 77280 (Ther rad simulaj field smpl) is highest relative to the nation at 198% of the national median; CPT 52000 (Cystourethroscopy) is lowest at 90%.
Methodology
- Source: in-network negotiated-rate files published under the federal Transparency in Coverage rule, August 2026 snapshot: UnitedHealthcare Choice plans (74 files); Aetna commercial plans (70 files); Cigna national PPO (1 files); BCBS licensees' own-network files (5,387 files). Payer comparisons describe these files, not each payer's entire book of business.
- Sample: rates come from a random sample of up to 150 providers per state and specialty. Counts on this page are sampled providers and TINs, not totals.
- Which providers count: only providers in a specialty relevant to the code, because a rate in a payer file attaches to a provider group and is listed under every provider in that group.
- Filters: fee-for-service, professional billing class, no modifier, negotiated or fee-schedule dollar rates. Rates outside 1% to 1,000% of the Medicare rate are excluded.
- Statistic: one median rate per provider, then percentiles across providers. A cell is shown only with at least 15 sampled providers and 4 TINs.
- Medicare benchmark: CY2026 national physician fee schedule, non-QPP conversion factor, unadjusted for locality. Where the non-facility rate is more than twice the facility rate (office rates that include device or supply cost), the facility rate is used so comparisons are like for like.
Benchmark your South Dakota contracts
Compare your negotiated rates with these state medians by payer and specialty.