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Texas 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
$849.42 / $2,252.25 / $6,319.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$720.72 / $952.38 / $1,544.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.67 / $3,190.33 / $6,640.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $682.11 / $1,801.80
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$900.90 / $1,228.95 / $1,801.80
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,287.00 / $1,287.00 / $1,287.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$836.55 / $2,417.63 / $5,562.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$617.76 / $816.76 / $1,953.60
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,059.19 / $6,113.25 / $6,113.25
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,435.00 / $6,435.00 / $9,652.50
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$772.20 / $1,287.00 / $1,580.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,287.00 / $1,287.00 / $1,287.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$836.55 / $1,544.40 / $2,895.75
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$772.20 / $1,287.00 / $2,359.07
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.35 / $1,287.00 / $1,953.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$540.54 / $540.54 / $836.55
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.93 / $514.79 / $1,287.00