go back

South Dakota rates for HCPCS 0295U

Oncology (breast ductal carcinoma in situ), protein expression profiling by immunohistochemistry of 7 proteins (COX2, FOXA1, HER2, Ki-67, p16, PR, SIAH2), with 4 clinicopathologic factors (size, age, margin status, palpability), utilizing formalin-fixed paraffin-embedded (FFPE) tissue, algorithm reported as a recurrence risk score

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.66 / $1,479.66 / $1,479.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,245.39 / $6,522.00 / $12,339.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,154.05 / $6,154.05 / $8,634.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$967.47 / $1,707.30 / $27,066.30
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,157.43 / $7,024.74 / $13,913.60
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,733.30 / $6,522.00 / $7,024.74
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,959.71 / $13,094.55 / $14,931.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$967.47 / $1,707.30 / $2,845.50
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,435.00 / $5,435.00 / $5,435.00