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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
$2,510.21 / $2,510.21 / $5,334.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$587.25 / $587.25 / $587.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,004.08 / $1,004.08 / $1,631.63
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,510.21 / $2,510.21 / $2,535.31
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,510.21 / $2,510.21 / $4,066.54
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$587.25 / $587.25 / $2,510.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,280.21 / $1,506.13 / $3,765.32