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Utah 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
$457.09 / $2,454.71 / $3,162.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $398.11 / $489.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $446.68 / $1,380.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $660.69
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $912.01 / $2,398.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $426.58 / $457.09
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $501.19 / $1,445.44
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $446.68 / $758.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $251.19 / $323.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $213.80 / $407.38