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South Dakota rates for HCPCS G0103

Prostate cancer screening; prostate specific antigen test (PSA)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.30 / $148.07 / $250.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.06 / $22.01 / $99.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.13 / $22.13 / $27.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.87 / $68.86 / $212.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.59 / $12.87 / $25.70
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.07 / $33.92 / $35.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.07 / $35.32 / $52.69
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.04 / $45.09 / $53.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.11 / $12.87 / $23.17
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.30 / $19.30 / $19.30