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South Dakota rates for HCPCS 81403

Molecular pathology procedure, Level 4 (eg, analysis of single exon by DNA sequence analysis, analysis of >10 amplicons using multiplex PCR in 2 or more independent reactions, mutation scanning or duplication/deletion variants of 2-5 exons)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$174.09 / $174.09 / $174.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $174.09 / $800.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$369.48 / $369.48 / $369.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.39 / $336.84 / $421.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.30 / $209.70 / $339.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.45 / $111.12 / $339.58
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$238.99 / $339.58 / $411.58
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.24 / $339.58 / $405.89
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.83 / $446.20 / $508.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.78 / $94.45 / $244.46
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.20 / $185.20 / $185.20