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South Dakota rates for HCPCS 84120

Porphyrins, urine; quantitation and fractionation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.88 / $50.12 / $97.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.55 / $10.96 / $15.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.18 / $28.18 / $28.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $28.18 / $35.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.80 / $22.91 / $69.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.91 / $10.23 / $20.42
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $35.48 / $40.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.17 / $10.23 / $25.70
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.79 / $14.79 / $14.79