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New Hampshire 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
Facility
Modifier
Low / Median / High Price
$941.53 / $2,068.84 / $5,884.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.46 / $680.93 / $680.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,382.87 / $1,536.71 / $3,278.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.26 / $546.41 / $645.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,517.95 / $3,072.79 / $3,687.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$966.01 / $966.01 / $1,207.51
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,140.93 / $1,494.00 / $2,990.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.07 / $504.39 / $504.39
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $3,000.00 / $4,410.00