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Maine 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
$2,511.89 / $2,511.89 / $4,073.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,737.80 / $2,454.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $1,202.26 / $1,621.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,754.40 / $5,754.40 / $5,754.40
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $3,019.95
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $2,511.89
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $1,659.59 / $2,454.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $2,511.89 / $3,630.78