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Montana 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
Professional
Modifier
Low / Median / High Price
$380.19 / $467.74 / $489.78
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $64,565.42 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $724.44 / $724.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $660.69 / $724.44
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $630.96 / $1,513.56
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $630.96 / $1,513.56
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $724.44 / $724.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $457.09 / $630.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $213.80 / $501.19