go back

South Dakota rates for HCPCS 0003U

Oncology (ovarian) biochemical assays of five proteins (apolipoprotein A-1, CA 125 II, follicle stimulating hormone, human epididymis protein 4, transferrin), utilizing serum, algorithm reported as a likelihood score

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$893.00 / $893.00 / $893.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.00 / $893.00 / $893.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,893.77 / $1,893.77 / $1,893.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,364.45 / $1,725.35 / $2,156.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$896.61 / $1,075.69 / $1,744.01
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$484.50 / $855.00 / $1,862.62
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,225.91 / $1,552.34 / $2,082.01
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,140.00 / $1,843.74 / $2,082.01
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,358.50 / $2,288.84 / $2,609.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$399.00 / $570.00 / $1,254.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$950.00 / $950.00 / $950.00