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Utah rates for HCPCS 81503

Oncology (ovarian), biochemical assays of five proteins (CA-125, apolipoprotein A1, beta-2 microglobulin, transferrin, and pre-albumin), utilizing serum, algorithm reported as a risk score

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $1,778.28 / $1,778.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $691.83 / $954.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $794.33 / $2,454.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,230.27 / $1,659.59
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,621.81 / $4,265.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $758.58 / $954.99
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $870.96 / $891.25
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $794.33 / $1,318.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $446.68 / $588.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $380.19 / $537.03