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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
$578.91 / $578.91 / $578.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$729.93 / $729.93 / $729.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$578.20 / $722.75 / $729.93
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$729.93 / $729.93 / $729.93
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$453.06 / $503.40 / $629.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.43 / $211.43 / $503.40