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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
$1,783.18 / $1,783.18 / $1,783.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.66 / $1,479.66 / $1,783.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,781.67 / $3,781.67 / $3,781.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,725.28 / $3,446.13 / $4,307.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,790.39 / $2,147.96 / $3,482.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$967.47 / $1,138.20 / $4,133.91
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,447.94 / $3,469.14 / $4,157.43
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,276.40 / $3,469.14 / $4,157.43
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,712.71 / $4,570.43 / $5,211.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$796.74 / $1,138.20 / $1,707.30
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,897.00 / $1,897.00 / $1,897.00