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South Dakota rates for HCPCS 81109

Human Platelet Antigen 5 genotyping (HPA-5), ITGA2 (integrin, alpha 2 [CD49B, alpha 2 subunit of VLA-2 receptor] [GPIa]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant (eg, HPA-5a/b (K505E))

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.89 / $114.89 / $114.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.89 / $95.33 / $114.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.49 / $243.49 / $243.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.77 / $221.95 / $277.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.36 / $138.38 / $224.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.33 / $76.95 / $249.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.72 / $249.00 / $312.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.66 / $249.00 / $267.86
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.77 / $294.45 / $335.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.33 / $76.95 / $122.22
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.22 / $122.22 / $122.22