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Virginia 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
$204.17 / $524.81 / $851.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $223.87 / $489.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $275.42 / $1,096.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $109.65 / $194.98
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $1,174.90 / $1,737.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $630.96 / $1,258.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $169.82 / $398.11
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $302.00 / $389.05
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $331.13 / $467.74
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $446.68 / $575.44
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $363.08 / $10,000.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $363.08 / $10,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $275.42 / $331.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $138.04 / $316.23