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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
$446.68 / $602.56 / $602.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $263.03 / $912.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $954.99 / $91,201.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $371.54 / $371.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $467.74 / $1,548.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $416.87 / $851.14
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $416.87 / $851.14
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $467.74 / $1,548.82
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $436.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $114.82 / $275.42