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South Dakota rates for HCPCS 86804

Hepatitis C Antibody Confirmatory Test

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.56 / $14.56 / $14.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.38 / $14.56 / $14.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.68 / $30.68 / $30.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.76 / $28.07 / $35.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.84 / $24.84 / $190.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.28 / $13.94 / $31.88
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.87 / $31.56 / $48.56
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.87 / $25.99 / $42.12
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.30 / $36.17 / $42.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.51 / $10.84 / $18.59
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $15.49