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Alaska rates for HCPCS 0017M

Oncology (diffuse large B-cell lymphoma [DLBCL]), mRNA, gene expression profiling by fluorescent probe hybridization of 20 genes, formalin-fixed paraffin-embedded tissue, algorithm reported as cell of origin

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,964.78 / $19,498.45 / $30,902.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $2,344.23 / $8,317.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,918.31 / $6,918.31 / $6,918.31
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $12,022.64
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $8,128.31
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $9,332.54 / $10,000.00
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,623.41 / $5,623.41 / $5,623.41
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $6,918.31 / $12,022.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $5,011.87 / $7,585.78