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South Dakota rates for HCPCS 0067U

Oncology (breast), immunohistochemistry, protein expression profiling of 4 biomarkers (matrix metalloproteinase-1 [MMP-1], carcinoembryonic antigen-related cell adhesion molecule 6 [CEACAM6], hyaluronoglucosaminidase [HYAL1], highly expressed in cancer protein [HEC1]), formalin-fixed paraffin-embedded precancerous breast tissue, algorithm reported as carcinoma risk score

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $2,137.96 / $2,137.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,445.44 / $2,187.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $3,630.78 / $3,630.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $3,630.78 / $4,570.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $2,137.96 / $3,467.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,148.15 / $9,549.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,290.87 / $2,290.87
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $4,466.84 / $5,248.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,148.15 / $2,187.76
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $1,905.46 / $1,905.46