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Michigan 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
$2,384.69 / $2,384.69 / $3,720.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,146.23 / $2,384.69 / $2,384.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,672.28 / $1,672.28 / $1,760.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,672.28 / $1,760.29 / $1,957.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,059.50 / $3,824.38 / $6,275.52
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,384.69 / $2,384.69 / $4,381.89
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,384.69 / $2,677.56 / $3,012.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,054.29 / $1,673.47 / $2,789.12