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Utah 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
$2,238.72 / $12,022.64 / $15,848.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,238.72 / $3,162.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $2,187.76 / $6,918.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,019.95 / $3,019.95 / $3,019.95
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $2,511.89 / $11,748.98
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,137.96 / $2,511.89
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $7,244.36
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,187.76 / $3,801.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,513.56