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Montana 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
Professional
Modifier
Low / Median / High Price
$1,480.05 / $8,275.41 / $8,275.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,724.58 / $1,724.58 / $1,724.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,866.15 / $2,509.65 / $3,803.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,478.95 / $1,866.15 / $1,866.15
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,866.15 / $2,509.65 / $3,803.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,158.30 / $1,287.00 / $1,866.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$540.54 / $540.54 / $1,287.00