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New Hampshire 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
$2,811.44 / $6,177.63 / $17,571.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,757.15 / $1,757.15 / $2,033.27
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,129.30 / $4,859.26 / $12,499.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,004.08 / $1,631.63 / $1,631.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,532.70 / $9,176.45 / $11,011.94
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,510.21 / $3,643.32 / $8,268.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,054.29 / $1,506.13 / $2,510.21
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,874.37 / $2,061.81 / $2,624.12