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Maine rates for HCPCS 0103U

Hereditary ovarian cancer (eg, hereditary ovarian cancer, hereditary endometrial cancer), genomic sequence analysis panel utilizing a combination of NGS, Sanger, MLPA, and array CGH, with mRNA analytics to resolve variants of unknown significance when indicated (24 genes [sequencing and deletion/duplication], EPCAM [deletion/duplication only])

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,743.95 / $1,743.95 / $3,705.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,743.95 / $1,743.95 / $1,743.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$697.58 / $697.58 / $1,133.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,384.63 / $2,384.63 / $2,384.63
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,743.95 / $1,743.95 / $1,761.39
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,743.95 / $1,743.95 / $2,825.20
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,743.95 / $1,743.95 / $1,743.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$570.16 / $670.79 / $1,743.95