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Maine 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
$1,287.00 / $1,287.00 / $3,217.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,042.47 / $1,042.47 / $1,287.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,245.43 / $1,563.32 / $4,449.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.79 / $566.28 / $2,289.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,745.14 / $2,745.14 / $2,745.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,155.59 / $1,302.51 / $1,848.69
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,287.00 / $1,287.00 / $1,299.86
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,287.00 / $1,287.00 / $3,217.50
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,042.47 / $1,287.00 / $1,287.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$772.20 / $772.20 / $1,866.15