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South Dakota rates for HCPCS 0002M

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 alcoholic steatohepatitis (ASH)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $467.74 / $575.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $389.05 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $660.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $489.78 / $2,398.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $257.04 / $602.56
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,174.90 / $1,380.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $302.00 / $660.69
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $501.19 / $501.19