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South Dakota 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
$258.33 / $258.33 / $258.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.00 / $258.33 / $412.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$547.70 / $547.70 / $547.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$394.93 / $499.39 / $624.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.32 / $311.20 / $696.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.16 / $164.90 / $503.91
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.65 / $503.91 / $610.75
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.80 / $503.91 / $602.32
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.01 / $662.15 / $755.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.43 / $164.90 / $274.83
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.83 / $274.83 / $274.83