The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 86305. Full schedules include every locality, modifier, and age-band variant.
- Every code on all 51 published schedules
- Full-schedule CSV export
- Full state Medicaid dental network lists
- Email alerts when a state changes its rates
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Publishing states
36
Median % of Medicare
97.5%
Rate range
$14.20 - $40.50
86305 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alaska | $20.81 | 100% | -- | 2026 |
| Alabama | $14.56 | 70% | -- | 2026 |
| California | $18.50 | 88.9% | -- | 2026 |
| Connecticut | $19.87 | 95.5% | -- | 2015 |
| District of Columbia | $16.65 | 80% | Not required | 2020 |
| Delaware | $20.39 | 98% | -- | 2026 |
| Hawaii | $29.81 | 143.2% | -- | 2025 |
| Iowa | $24.83 | 119.3% | -- | 2024 |
| Idaho | $17.98 | 86.4% | Not required | 2025 |
| Illinois | $16.71 | 80.3% | -- | 2013 |
| Indiana | $20.81 | 100% | -- | 2020 |
| Kansas | $17.69 | 85% | -- | 2023 |
| Kentucky | $20.81 | 100% | -- | 2026 |
| Louisiana | $20.53 | 98.7% | -- | 2026 |
| Massachusetts | $18.35 | 88.2% | -- | 2024 |
| Maine | $20.81 | 100% | -- | 2026 |
| Michigan | $17.23 | 82.8% | -- | 2026 |
| Missouri | $18.73 | -- | Not required | 2026 |
| North Dakota | $20.81 | 100% | Not required | 2026 |
| Nebraska | $20.81 | 100% | -- | 2026 |
| New Hampshire | $18.00 | 86.5% | Not required | 2026 |
| New Jersey | $16.65 | 80% | Not required | 2026 |
| New Mexico | $20.81 | 100% | -- | 2023 |
| Nevada | $14.20 | -- | -- | 2017 |
| Ohio | $15.61 | 75% | -- | 2021 |
| Oklahoma | $18.51 | 88.9% | -- | 2026 |
| Oregon | $16.65* | 80% | -- | 2026 |
| Pennsylvania | $23.85 | -- | -- | 2011 |
| Rhode Island | $40.50 | -- | -- | 2026 |
| South Carolina | $26.83 | -- | -- | 2026 |
| Texas | $28.51* | 137% | -- | 2021 |
| Virginia | $20.81 | 100% | -- | 2020 |
| Vermont | $20.29 | 97.5% | -- | 2026 |
| Washington | $16.65 | 80% | -- | 2026 |
| Wisconsin | $20.81 | 100% | -- | 2020 |
| Wyoming | $26.16 | 125.7% | -- | 2021 |
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Rows marked * are representative published variants or methodology-derived rates. "--" in the prior-auth column means the state publishes no PA flag.
Related lab & imaging codes
- 70030 - X-ray of the eye for a foreign body
- 70100 - Jaw (mandible) X-ray, up to 3 views
- 70110 - Jaw (mandible) X-ray, 4 or more views
- 70120 - X-ray of the mastoids, under 3 views per side
- 70130 - X-ray of the mastoids, complete
- 70134 - X-ray of the inner ear canals, complete
- 70140 - Facial bone X-ray, under 3 views
- 70150 - Facial bone X-ray, complete, 3 or more views
Frequently asked questions
How much does Medicaid pay for 86305?
36 state Medicaid programs publish a fee-for-service rate for 86305 (hE4 tumor marker level (ovarian cancer)), ranging from $14.20 in Nevada to $40.50 in Rhode Island, with a median of 97.5% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for 86305?
Rhode Island publishes the highest Medicaid rate for 86305 at $40.50. Nevada publishes the lowest at $14.20.
Does 86305 require prior authorization under Medicaid?
No publishing state flags 86305 with a prior-authorization indicator on its fee schedule. Absence of a flag means the state publishes none, not that PA is never required - confirm through the state's provider manual.