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Maine rates for HCPCS 0120U

Oncology (B-cell lymphoma classification), mRNA, gene expression profiling by fluorescent probe hybridization of 58 genes (45 content and 13 housekeeping genes), formalin-fixed paraffin-embedded tissue, algorithm reported as likelihood for primary mediastinal B-cell lymphoma (PMBCL) and diffuse large B-cell lymphoma (DLBCL) with cell of origin subtyping in the latter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,510.21 / $2,510.21 / $5,334.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,033.27 / $2,033.27 / $2,033.27
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,429.13 / $3,049.15 / $8,677.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,004.08 / $1,004.08 / $1,631.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,949.13 / $5,949.13 / $5,949.13
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,510.21 / $2,510.21 / $2,535.31
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,510.21 / $2,510.21 / $4,066.54
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,033.27 / $2,033.27 / $2,510.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,506.13 / $1,673.47 / $4,183.68