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Michigan 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
$2,398.83 / $2,398.83 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,137.96 / $3,019.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $1,778.28 / $1,778.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,778.28 / $1,778.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,754.23 / $2,754.23 / $3,467.37
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $6,025.60
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,511.89 / $3,388.44
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,754.23 / $2,754.23 / $2,754.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $2,511.89 / $3,019.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,513.56 / $2,511.89