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South Dakota rates for HCPCS 97004

Occupational Therapy Re-Evalua

Insurance Carrier
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.99 / $52.00 / $52.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.18 / $45.89 / $165.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.12 / $233.87 / $233.87
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.12 / $59.88 / $107.01
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.11 / $63.50 / $87.31