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Montana rates for HCPCS 80076

Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155) Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate amino (AST) (SGOT) (84450)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.17 / $72.73 / $176.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.40 / $9.76 / $13.07
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.95 / $10.95 / $77,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.95 / $10.95 / $10.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.85 / $15.93 / $24.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.61 / $11.85 / $11.87
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.85 / $13.89 / $24.14
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.35 / $8.17 / $11.85
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.17 / $8.17 / $8.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.43 / $3.43 / $11.23