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Washington 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
$2,344.23 / $11,220.18 / $25,118.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,041.74 / $3,019.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $5,623.41 / $6,456.54
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $2,511.89 / $11,748.98
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,511.89 / $4,265.80
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $2,754.23 / $4,365.16
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $4,365.16 / $7,585.78
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,238.72 / $3,019.95
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $3,801.89 / $6,918.31
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,238.72 / $2,818.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $3,019.95 / $3,019.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $2,818.38
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $2,511.89 / $4,466.84