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South Dakota rates for HCPCS 87903

Nfct Phexyp Resist Tiss Cul Hiv First 1-10 Drugs

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$459.34 / $459.34 / $459.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.39 / $381.15 / $459.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$973.98 / $973.98 / $973.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$687.07 / $887.81 / $1,109.76
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$468.18 / $755.49 / $955.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$293.20 / $439.79 / $4,017.97
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.58 / $1,070.94 / $1,531.95
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$586.39 / $995.55 / $1,399.94
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$797.98 / $1,177.33 / $1,342.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.24 / $341.86 / $682.72
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.66 / $488.66 / $488.66