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Wisconsin 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
$4,786.30 / $4,786.30 / $4,786.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,318.26 / $1,513.56
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $338.84 / $6,165.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,786.30 / $5,623.41 / $8,912.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $4,365.16 / $5,495.41
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $7,244.36 / $10,964.78
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,471.29 / $10,471.29 / $11,481.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $2,089.30 / $6,165.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $676.08 / $8,709.64
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $64.57 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $4,073.80 / $5,754.40
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $8,317.64 / $8,317.64
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $6,918.31 / $8,709.64
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.35 / $3,715.35 / $3,715.35
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,011.87 / $9,549.93 / $9,549.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $2,089.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $676.08 / $1,995.26