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New Hampshire 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
$6,309.57 / $6,309.57 / $17,378.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,737.80 / $2,187.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,365.16 / $4,786.30 / $14,454.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $1,621.81 / $2,344.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $7,943.28 / $10,964.78
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $4,786.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,513.56 / $2,511.89