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South Dakota rates for HCPCS 84620

Xylose absorption test, blood and/or urine

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.14 / $12.14 / $12.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.65 / $12.14 / $12.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.46 / $25.46 / $25.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.87 / $23.50 / $29.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.37 / $18.98 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.75 / $11.62 / $24.38
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.66 / $24.14 / $40.47
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.66 / $26.33 / $33.94
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.34 / $30.15 / $35.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.42 / $8.28 / $15.49
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.91 / $12.91 / $12.91