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Pennsylvania rates for HCPCS 0012M

Oncology (urothelial), mRNA, gene expression profiling by real-time quantitative PCR of five genes (MDK, HOXA13, CDC2 [CDK1], IGFBP5, and CXCR2), utilizing urine, algorithm reported as a risk score for having urothelial carcinoma

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$646.00 / $2,622.46 / $3,178.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$456.00 / $615.60 / $646.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$592.79 / $592.79 / $592.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$508.82 / $988.00 / $2,522.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,663.20 / $3,663.20 / $3,663.20
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$798.00 / $1,026.00 / $1,877.20
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$782.80 / $2,157.64 / $3,138.80
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.79 / $646.00 / $3,138.80
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,124.80 / $1,140.00 / $1,520.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$508.82 / $988.00 / $2,522.01
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,663.20 / $3,663.20 / $3,663.20
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$760.00 / $760.00 / $836.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$760.00 / $760.00 / $836.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.20 / $456.00 / $1,014.75