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South Dakota rates for HCPCS 0051U

Prescription drug monitoring, evaluation of drugs present by liquid chromatography tandem mass spectrommetry (LC-MS/MS), urine or blood, 31 drug panel, reported as quantitative results, detected or not detected, per date of service

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $181.97 / $281.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $181.97 / $234.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $478.63 / $478.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $478.63 / $588.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $281.84 / $1,174.90
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $104.71 / $295.12
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $575.44 / $676.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $117.49 / $309.03
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $245.47