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South Dakota rates for HCPCS 87904

Infectious agent phenotype analysis by nucleic acid (DNA or RNA) with drug resistance tissue culture analysis, HIV 1; each additional drug tested (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.99 / $23.99 / $29.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $23.99 / $141.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $50.12 / $50.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $50.12 / $63.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.55 / $40.74 / $51.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $18.20 / $812.83
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $63.10 / $72.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $18.20 / $36.31
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $26.30 / $26.30