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Utah rates for HCPCS 0247U

Obstetrics (preterm birth), insulin-like growth factor-binding protein 4 (IBP4), sex hormone-binding globulin (SHBG), quantitative measurement by LC-MS/MS, utilizing maternal serum, combined with clinical data, reported as predictive-risk stratification for spontaneous preterm birth

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$675.00 / $3,537.00 / $4,637.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$495.00 / $592.50 / $862.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$641.05 / $659.33 / $2,066.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.93 / $861.93 / $1,077.41
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$750.00 / $862.50 / $900.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.09 / $586.77 / $637.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.00 / $315.00 / $450.00