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Utah 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
Facility
Modifier
Low / Median / High Price
$1,698.24 / $9,120.11 / $12,022.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,698.24 / $2,398.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $1,659.59 / $5,248.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,290.87 / $2,290.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $79.43
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $2,290.87 / $8,912.51
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,698.24 / $1,905.46
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,318.26 / $5,495.41
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,659.59 / $2,818.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $794.33 / $1,148.15