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Maine 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
$503.40 / $503.40 / $1,069.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.75 / $407.75 / $407.75
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487.14 / $611.48 / $1,740.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.36 / $327.20 / $327.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,073.74 / $1,073.74 / $1,073.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.00 / $525.00 / $656.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$503.40 / $503.40 / $609.62
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$503.40 / $503.40 / $815.51
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.75 / $407.75 / $528.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.04 / $302.04 / $729.93