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Montana rates for HCPCS 81596

Infectious disease, chronic hepatitis C virus (HCV) infection, six biochemical assays (ALT, A2-macroglobulin, apolipoprotein A-1, total bilirubin, GGT, and haptoglobin) utilizing serum, prognostic algorithm reported as scores for fibrosis and necroinflammatory activity in liver

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.59 / $206.15 / $367.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.79 / $52.57 / $464.18
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.73 / $96.73 / $91,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.73 / $96.73 / $96.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.68 / $140.77 / $213.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.02 / $103.77 / $104.68
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.68 / $140.77 / $213.32
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.97 / $64.97 / $104.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.32 / $72.19