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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
$24.51 / $24.51 / $24.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.47 / $20.32 / $24.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.22 / $52.22 / $52.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.88 / $47.65 / $59.57
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.98 / $40.44 / $50.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.64 / $23.46 / $810.43
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.64 / $57.14 / $81.73
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.28 / $53.12 / $76.45
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.58 / $62.81 / $71.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.95 / $18.23 / $26.07
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.07 / $26.07 / $26.07