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Wisconsin 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
$3,019.95 / $6,918.31 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,041.74 / $3,019.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $302.00 / $8,912.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,918.31 / $8,128.31 / $12,882.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $3,311.31 / $7,762.47
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.23 / $10,471.29 / $15,848.93
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,135.61 / $15,135.61 / $16,595.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $3,019.95 / $8,709.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,513.56 / $12,589.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $70.79 / $2,511.89
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,073.80 / $5,888.44 / $8,317.64
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $12,022.64 / $12,022.64
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,630.78 / $10,000.00 / $12,589.25
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,370.32 / $5,370.32 / $5,370.32
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,803.84 / $13,803.84 / $13,803.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $3,019.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,513.56 / $4,168.69