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New Hampshire 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
$1,288.25 / $1,288.25 / $3,548.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $354.81 / $407.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $1,659.59 / $2,884.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $323.59 / $371.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $1,584.89 / $2,187.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $524.81 / $660.69
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $831.76 / $954.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $302.00 / $501.19