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Montana 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
Professional
Modifier
Low / Median / High Price
$2,886.74 / $2,886.74 / $2,886.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,639.80 / $3,639.80 / $3,639.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,639.80 / $3,639.80 / $3,639.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,639.80 / $3,639.80 / $3,639.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,259.19 / $2,259.19 / $3,639.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,054.29 / $1,054.29 / $2,510.21