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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
$64.97 / $340.44 / $446.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.65 / $54.14 / $76.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.70 / $63.46 / $198.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.17 / $83.01 / $103.77
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.55 / $55.55 / $55.55
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.19 / $83.02 / $292.37
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.26 / $58.87 / $83.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.32 / $43.31