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Wisconsin rates for HCPCS 81315

PML/RARalpha, (t(15;17)), (promyelocytic leukemia/retinoic acid receptor alpha) (eg, promyelocytic leukemia) translocation analysis; common breakpoints (eg, intron 3 and intron 6), qualitative or quantitative

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.77 / $310.97 / $462.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.63 / $196.94 / $429.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$445.72 / $539.01 / $570.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.38 / $207.31 / $891.43
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.95 / $562.95 / $585.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$570.41 / $666.57 / $1,022.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.30 / $558.24 / $634.36
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.63 / $248.77 / $725.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.58 / $248.77 / $725.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.97 / $169.70 / $746.32
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $207.31
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.63 / $248.77 / $725.59
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.65 / $540.07 / $705.10
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$448.39 / $984.72 / $984.72
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.60 / $1,036.55 / $1,036.55
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.29 / $213.29 / $441.48
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.29 / $702.50 / $1,131.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.28 / $184.28 / $499.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.79 / $165.85 / $593.94