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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
$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
$2,789.64 / $3,220.45 / $3,753.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.36 / $201.36 / $427.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$578.20 / $578.20 / $722.75
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 / $503.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.04 / $302.04 / $729.93