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Maine 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
Facility
Modifier
Low / Median / High Price
$501.19 / $501.19 / $812.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $389.05 / $489.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $3,235.94 / $3,467.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $302.00 / $501.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,148.15 / $1,148.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $575.44 / $724.44
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $501.19 / $616.60
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $501.19 / $501.19
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $407.38 / $501.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $302.00 / $758.58