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South Dakota rates for HCPCS 81412

Ashkenazi Jewish associated disorders (eg, Bloom syndrome, Canavan disease, cystic fibrosis, familial dysautonomia, Fanconi anemia group C, Gaucher disease, Tay-Sachs disease), genomic sequence analysis panel, must include sequencing of at least 9 genes, including ASPA, BLM, CFTR, FANCC, GBA, HEXA, IKBKAP, MCOLN1, and SMPD1

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,301.65 / $2,301.65 / $2,301.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.00 / $600.00 / $2,301.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,881.64 / $4,881.64 / $4,881.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,813.77 / $4,447.53 / $5,559.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,310.94 / $2,772.51 / $11,630.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.07 / $1,469.14 / $4,489.68
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$975.40 / $3,183.13 / $5,366.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.40 / $3,196.38 / $6,390.74
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,448.56 / $5,899.32 / $6,726.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.07 / $1,028.40 / $2,448.56
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,448.56 / $2,448.56 / $2,448.56