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South Dakota rates for HCPCS 0025U

Tenofovir, by liquid chromatography with tandem mass spectrometry (LC-MS/MS), urine, quantitative

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.62 / $80.62 / $80.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.62 / $80.62 / $80.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$171.03 / $171.03 / $171.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.06 / $208.24 / $260.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.95 / $129.57 / $543.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.60 / $77.19 / $142.94
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.68 / $181.43 / $186.86
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.68 / $186.86 / $223.86
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.77 / $267.20 / $314.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.06 / $51.46 / $137.32
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.43 / $114.43 / $114.43