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Utah rates for HCPCS 80426

Gonadotropin releasing hormone stimulation panel This panel must include the following: Follicle stimulating hormone (FSH) (83001 x 4) Luteinizing hormone (LH) (83002 x 4)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $977.24 / $1,288.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $120.23 / $181.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $131.83 / $407.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $169.82 / $229.09
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $537.03 / $794.33
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $125.89 / $134.90
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $147.91 / $467.74
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $147.91 / $223.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $74.13 / $95.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $87.10 / $204.17