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South Dakota rates for HCPCS 0017M

Oncology (diffuse large B-cell lymphoma [DLBCL]), mRNA, gene expression profiling by fluorescent probe hybridization of 20 genes, formalin-fixed paraffin-embedded tissue, algorithm reported as cell of origin

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $2,344.23 / $2,884.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,905.46 / $2,884.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $2,630.27 / $3,311.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $2,818.38 / $4,570.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,513.56 / $12,589.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,019.95 / $3,019.95 / $3,019.95
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,630.78 / $5,888.44 / $6,918.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,513.56 / $2,884.03
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $2,511.89