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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
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,096.48 / $1,479.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $2,511.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $2,511.89
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $2,344.23 / $5,248.07
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,344.23 / $5,248.07
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $2,511.89 / $3,801.89
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,584.89 / $2,511.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $467.74 / $1,122.02