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Montana rates for HCPCS 81105

Human Platelet Antigen 1 genotyping (HPA-1), ITGB3 (integrin, beta 3 [platelet glycoprotein IIIa], antigen CD61 [GPIIIa]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-1a/b (L33P)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $114.82 / $812.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $208.93 / $691.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $70.79 / $177.83
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.03 / $158.49 / $371.54
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $158.49 / $371.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $208.93 / $691.83
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $109.65 / $194.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $51.29 / $123.03