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Utah rates for HCPCS 81316

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$388.25 / $388.25 / $862.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.25 / $388.25 / $388.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.20 / $182.25 / $571.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.59 / $248.77 / $441.15
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$207.31 / $238.41 / $963.99
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.72 / $364.77 / $549.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.07 / $124.39 / $181.18