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South Dakota rates for HCPCS 81500

Oncology (ovarian), biochemical assays of two proteins (CA-125 and HE4), utilizing serum, with menopausal status, algorithm reported as a risk score

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$244.87 / $244.87 / $244.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.54 / $203.19 / $244.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$519.63 / $519.63 / $519.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.43 / $473.28 / $591.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $245.86 / $1,237.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.86 / $234.45 / $477.65
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$336.15 / $477.65 / $578.91
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.60 / $477.65 / $679.91
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.52 / $627.62 / $715.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.41 / $156.30 / $312.60
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.50 / $260.50 / $260.50