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South Dakota rates for HCPCS 81257

HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; common deletions or variant (eg, Southeast Asian, Thai, Filipino, Mediterranean, alpha3.7, alpha4.2, alpha20.5, Constant Spring)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.12 / $96.12 / $96.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.13 / $79.76 / $145.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.67 / $203.67 / $203.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.62 / $185.40 / $231.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.51 / $115.78 / $218.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.15 / $61.36 / $187.50
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.96 / $187.50 / $227.24
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.71 / $187.50 / $224.10
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.22 / $246.38 / $280.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.95 / $52.15 / $102.26
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.26 / $102.26 / $102.26