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Utah rates for HCPCS 84030

Phenylalanine (PKU), blood

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.96 / $21.88 / $28.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $3.98 / $6.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.68 / $4.79 / $15.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.47 / $6.61 / $10.72
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.50 / $13.18 / $28.84
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.72 / $4.68 / $4.90
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.89 / $5.50 / $17.38
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.47 / $4.79 / $8.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.75 / $2.75 / $10.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $3.31 / $33.11