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South Dakota rates for HCPCS 84030

Assay Of Phenylalanine Blood

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.17 / $5.17 / $249.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.69 / $5.17 / $5.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.10 / $11.10 / $11.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.20 / $9.78 / $12.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.28 / $8.82 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.75 / $4.95 / $8.09
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.09 / $11.20 / $17.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.93 / $12.05 / $15.75
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.47 / $12.84 / $15.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.75 / $5.50 / $33.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $5.50 / $5.50