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South Dakota rates for HCPCS 0155U

Oncology (breast cancer), DNA, PIK3CA (phosphatidylinositol-4,5-bisphosphate 3-kinase, catalytic subunit alpha) (eg, breast cancer) gene analysis (ie, p.C420R, p.E542K, p.E545A, p.E545D [g.1635G>T only], p.E545G, p.E545K, p.Q546E, p.Q546R, p.H1047L, p.H1047R, p.H1047Y), utilizing formalin-fixed paraffin-embedded breast tumor tissue, reported as PIK3CA gene mutation status

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$258.33 / $258.33 / $258.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.14 / $214.37 / $258.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$547.70 / $547.70 / $547.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$394.93 / $499.39 / $624.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$259.39 / $311.20 / $504.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.16 / $164.90 / $540.85
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.65 / $502.59 / $602.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.80 / $502.59 / $602.32
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.01 / $662.15 / $755.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.43 / $140.16 / $274.83
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.83 / $274.83 / $274.83