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South Dakota rates for HCPCS 81315

PML/RARalpha, (t(15;17)), (promyelocytic leukemia/retinoic acid receptor alpha) (eg, promyelocytic leukemia) translocation analysis; common breakpoints (eg, intron 3 and intron 6), qualitative or quantitative

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.87 / $194.87 / $194.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.90 / $161.69 / $194.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$413.22 / $413.22 / $413.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$297.88 / $376.67 / $470.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.65 / $234.74 / $380.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.39 / $145.03 / $426.57
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.52 / $454.33 / $581.39
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.77 / $422.37 / $581.39
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.54 / $499.47 / $569.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.07 / $124.39 / $207.31
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.31 / $207.31 / $207.31