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Pennsylvania 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
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.64 / $172.50 / $361.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.47 / $37.77 / $54.98
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.91 / $23.91 / $23.91
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.81 / $8,459.92 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.29 / $37.29 / $37.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.42 / $62.16 / $158.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.18 / $53.94 / $73.63
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.99 / $28.21 / $64.73
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.08 / $111.34 / $212.67
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.00 / $46.00 / $46.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.72 / $135.56 / $364.33
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.57 / $38.43 / $197.46
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.01 / $67.42 / $158.63
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.18 / $53.94 / $73.63
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.65 / $47.81 / $71.63
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.65 / $47.81 / $71.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.07 / $28.69 / $83.19