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Vermont 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
$3,090.30 / $3,090.30 / $3,090.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $223.87 / $263.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $602.56 / $616.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $691.83 / $691.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $275.42 / $616.60
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $275.42 / $275.42
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $275.42 / $275.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $275.42 / $630.96