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South Dakota rates for HCPCS 0164U

Gastroenterology (irritable bowel syndrome [IBS]), immunoassay for anti-CdtB and anti-vinculin antibodies, utilizing plasma, algorithm for elevated or not elevated qualitative results

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.71 / $104.71 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $87.10 / $134.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $213.80 / $269.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.71 / $125.89 / $537.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $57.54 / $134.90
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $263.03 / $309.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $67.61 / $147.91
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $112.20