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Indiana rates for HCPCS 0003M

Liver disease, ten biochemical assays (ALT, A2-macroglobulin, apolipoprotein A-1, total bilirubin, GGT, haptoglobin, AST, glucose, total cholesterol and triglycerides) utilizing serum, prognostic algorithm reported as quantitative scores for fibrosis, steatosis and nonalcoholic steatohepatitis (NASH)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $794.33 / $1,862.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $407.38 / $489.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $501.19 / $1,513.56
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $199.53 / $389.05
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $7,244.36 / $43,651.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $501.19 / $501.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $524.81 / $660.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $501.19 / $501.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $302.00 / $501.19