go back

South Dakota rates for HCPCS 0011U

Prescription drug monitoring, evaluation of drugs present by LC-MS/MS, using oral fluid, reported as a comparison to an estimated steady-state range, per date of service including all drug compounds and metabolites

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $107.15 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $85.11 / $131.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $218.78 / $218.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $218.78 / $275.42
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $109.65 / $208.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $69.18 / $575.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $269.15 / $316.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $69.18 / $131.83
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $114.82 / $114.82