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Montana 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
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,528.73 / $2,528.73 / $2,528.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,528.73 / $2,528.73 / $2,528.73
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,528.73 / $2,528.73 / $2,528.73
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,569.56 / $1,569.56 / $2,528.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$469.55 / $469.55 / $1,117.98