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Vermont 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
Professional
Modifier
Low / Median / High Price
$588.84 / $2,137.96 / $3,090.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,168.69 / $4,168.69 / $4,168.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $2,511.89
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $2,511.89
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $2,511.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,513.56 / $5,754.40