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South Dakota rates for HCPCS 84375

Sugars Chromatographic Tlc/Paper Chromatography

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.65 / $36.65 / $36.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.13 / $36.65 / $36.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.68 / $77.68 / $77.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.02 / $71.16 / $88.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.44 / $44.16 / $185.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.72 / $35.10 / $46.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.97 / $70.95 / $71.50
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.65 / $46.84 / $101.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.28 / $91.07 / $107.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.72 / $23.40 / $40.35
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.00 / $39.00 / $39.00