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Montana rates for HCPCS 0166U

Liver disease, 10 biochemical assays (a2-macroglobulin, haptoglobin, apolipoprotein A1, bilirubin, GGT, ALT, AST, triglycerides, cholesterol, fasting glucose) and biometric and demographic data, utilizing serum, algorithm reported as scores for fibrosis, necroinflammatory activity, and steatosis with a summary interpretation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $467.74 / $489.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $724.44 / $724.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $724.44 / $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