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Utah rates for HCPCS 81257

HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; common deletions or variant (eg, Southeast Asian, Thai, Filipino, Mediterranean, alpha3.7, alpha4.2, alpha20.5, Constant Spring)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.69 / $129.69 / $288.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.69 / $129.69 / $129.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.41 / $89.90 / $281.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.98 / $109.67 / $186.92
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.26 / $117.60 / $414.15
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.58 / $113.29 / $208.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.95 / $61.36 / $61.36