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Nationwide rates for HCPCS 80055

Obstetric panel This panel must include the following: Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009) Hepatitis B surface antigen (HBsAg) (87340) Antibody, rubella (86762) Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART) (86592) Antibody screen, RBC, each serum technique (86850) Blood typing, ABO (86900) AND Blood typing, Rh (D) (86901)

Insurance Carrier	Facility/Professional	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $43.39 / $84.59 / $293.45	Facility	$43.39	$84.59	$293.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.83 / $37.77 / $47.81	Professional	$34.83	$37.77	$47.81
BCBS Facility/Professional Facility Modifier Low / Median / High Price $47.81 / $58.07 / $165.28	Facility	$47.81	$58.07	$165.28
BCBS Facility/Professional Professional Modifier Low / Median / High Price $23.61 / $23.61 / $69.51	Professional	$23.61	$23.61	$69.51
Cigna Facility/Professional Facility Modifier Low / Median / High Price $33.40 / $77.34 / $154.28	Facility	$33.40	$77.34	$154.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $27.27 / $54.93 / $69.59	Professional	$27.27	$54.93	$69.59
United Facility/Professional Facility Modifier Low / Median / High Price $47.81 / $47.81 / $47.81	Facility	$47.81	$47.81	$47.81
United Facility/Professional Professional Modifier Low / Median / High Price $20.07 / $28.69 / $63.22	Professional	$20.07	$28.69	$63.22

Nationwide rates for HCPCS 80055

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