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South Dakota rates for HCPCS 85004

Blood count; automated differential WBC count

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.08 / $6.08 / $98.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $5.64 / $29.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.06 / $13.06 / $13.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.43 / $11.75 / $14.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.19 / $10.38 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.88 / $5.82 / $13.31
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.34 / $13.16 / $20.28
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.34 / $14.19 / $18.54
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.57 / $15.59 / $17.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.72 / $4.51 / $8.53
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.47 / $6.47 / $6.47