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Montana rates for HCPCS 0067U

Oncology (breast), immunohistochemistry, protein expression profiling of 4 biomarkers (matrix metalloproteinase-1 [MMP-1], carcinoembryonic antigen-related cell adhesion molecule 6 [CEACAM6], hyaluronoglucosaminidase [HYAL1], highly expressed in cancer protein [HEC1]), formalin-fixed paraffin-embedded precancerous breast tissue, algorithm reported as carcinoma risk score

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,181.55 / $3,600.00 / $3,600.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,750.65 / $2,750.65 / $2,750.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,750.65 / $2,750.65 / $2,750.65
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,750.65 / $2,750.65 / $2,750.65
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,707.30 / $1,707.30 / $2,750.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$796.74 / $796.74 / $1,897.00