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Utah 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
$64.57 / $346.74 / $457.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $56.23 / $75.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $63.10 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $93.33 / $112.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $54.95 / $54.95
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $218.78 / $346.74
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $61.66 / $64.57
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $72.44 / $229.09
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $63.10 / $107.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $36.31 / $46.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $57.54