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Montana rates for HCPCS 0312U

Autoimmune diseases (eg, systemic lupus erythematosus [SLE]), analysis of 8 IgG autoantibodies and 2 cell-bound complement activation products using enzyme-linked immunosorbent immunoassay (ELISA), flow cytometry and indirect immunofluorescence, serum, or plasma and whole blood, individual components reported along with an algorithmic SLE-likelihood assessment

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,334.50 / $2,334.50 / $2,334.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,218.94 / $1,218.94 / $1,218.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$966.01 / $1,207.51 / $1,218.94
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,218.94 / $1,218.94 / $1,218.94
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$840.65 / $1,008.78 / $1,218.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.07 / $353.07 / $840.65