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Montana rates for HCPCS 81404

Molecular pathology procedure, Level 5 (eg, analysis of 2-5 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 6-10 exons, or characterization of a dynamic mutation disorder/triplet repeat by Southern blot analysis)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$448.20 / $448.20 / $607.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.00 / $400.00 / $1,767.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$368.27 / $957.50 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$368.27 / $368.27 / $368.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.50 / $467.21 / $1,566.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.50 / $398.50 / $398.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.50 / $467.21 / $1,566.53
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.35 / $247.35 / $398.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.43 / $115.43 / $274.83