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South Dakota rates for HCPCS 81471

X-linked intellectual disability (XLID) (eg, syndromic and non-syndromic XLID); duplication/deletion gene analysis, must include analysis of at least 60 genes, including ARX, ATRX, CDKL5, FGD1, FMR1, HUWE1, IL1RAPL, KDM5C, L1CAM, MECP2, MED12, MID1, OCRL, RPS6KA3, and SLC16A2

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,986.00 / $4,986.00 / $4,986.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,821.96 / $1,821.96 / $1,821.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,312.82 / $1,660.07 / $2,075.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$466.14 / $548.40 / $1,675.91
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,179.45 / $1,675.91 / $2,339.84
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.80 / $1,675.91 / $2,003.11
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,307.02 / $2,202.10 / $2,510.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.88 / $548.40 / $822.60
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$914.00 / $914.00 / $914.00