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South Dakota rates for HCPCS 0120U

Oncology (B-cell lymphoma classification), mRNA, gene expression profiling by fluorescent probe hybridization of 58 genes (45 content and 13 housekeeping genes), formalin-fixed paraffin-embedded tissue, algorithm reported as likelihood for primary mediastinal B-cell lymphoma (PMBCL) and diffuse large B-cell lymphoma (DLBCL) with cell of origin subtyping in the latter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,359.60 / $2,359.60 / $2,359.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,681.84 / $1,957.96 / $2,359.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,004.35 / $5,004.35 / $5,004.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,605.49 / $4,559.16 / $5,698.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,369.14 / $2,842.31 / $4,608.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,422.45 / $1,506.13 / $5,488.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,239.25 / $4,590.55 / $6,426.14
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,012.25 / $4,590.55 / $5,501.34
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,589.60 / $6,047.85 / $6,896.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,054.29 / $1,506.13 / $2,259.19
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,510.21 / $2,510.21 / $2,510.21