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South Dakota rates for HCPCS 86305

Human epididymis protein 4 (HE4)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.05 / $19.05 / $23.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $15.85 / $23.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $39.81 / $50.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.50 / $29.51 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.59 / $14.45 / $29.51
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $50.12 / $57.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.71 / $14.45 / $36.31
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $20.89