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South Dakota rates for HCPCS B4083

Stomach Tube - Levine Type (Special Coverage Instructions Apply. See Cim: 65-10 And Mcm: 2130 4450)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.17 / $2.17 / $2.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.17 / $2.17 / $2.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.25 / $2.27 / $2.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.84 / $3.25 / $4.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $2.16 / $3.78
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.52 / $2.98 / $3.47
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.72 / $3.47 / $5.64
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.94 / $2.25 / $2.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $1.98 / $5.04
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.71 / $2.71 / $2.71