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Indiana rates for HCPCS 81460

Whole mitochondrial genome (eg, Leigh syndrome, mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes [MELAS], myoclonic epilepsy with ragged-red fibers [MERFF], neuropathy, ataxia, and retinitis pigmentosa [NARP], Leber hereditary optic neuropathy [LHON]), genomic sequence, must include sequence analysis of entire mitochondrial genome with heteroplasmy detection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,055.33 / $1,480.05 / $4,749.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,016.73 / $1,055.33 / $1,287.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,016.73 / $1,151.86 / $3,861.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $514.79 / $800.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,287.00 / $1,544.40 / $1,801.80
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,287.00 / $1,480.05 / $1,866.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$836.55 / $1,287.00 / $2,994.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$679.54 / $1,478.95 / $1,848.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$540.54 / $772.20 / $1,287.00