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South Dakota 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
$1,209.78 / $1,209.78 / $1,209.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$862.29 / $1,003.86 / $1,209.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,565.50 / $2,565.50 / $2,565.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,478.95 / $2,337.67 / $2,922.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $1,214.67 / $6,113.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.37 / $1,158.30 / $2,359.84
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,660.79 / $2,359.84 / $2,860.06
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,544.40 / $2,359.84 / $3,359.07
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,840.41 / $3,100.77 / $3,535.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$540.54 / $1,158.30 / $1,698.84
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,287.00 / $1,287.00 / $1,287.00