go back

South Dakota rates for HCPCS 81442

Noonan spectrum disorders (eg, Noonan syndrome, cardio-facio-cutaneous syndrome, Costello syndrome, LEOPARD syndrome, Noonan-like syndrome), genomic sequence analysis panel, must include sequencing of at least 12 genes, including BRAF, CBL, HRAS, KRAS, MAP2K1, MAP2K2, NRAS, PTPN11, RAF1, RIT1, SHOC2, and SOS1

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,014.98 / $2,014.98 / $2,014.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,436.21 / $1,672.01 / $2,014.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,273.88 / $4,273.88 / $4,273.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,463.13 / $3,893.30 / $4,866.62
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,023.14 / $2,427.19 / $10,182.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.07 / $1,286.16 / $3,930.50
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$975.40 / $2,786.68 / $4,697.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.40 / $2,798.29 / $5,594.80
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,143.60 / $5,164.58 / $5,888.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.07 / $1,286.16 / $1,929.24
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,143.60 / $2,143.60 / $2,143.60