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Vermont 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
$1,757.15 / $3,112.66 / $3,112.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,201.47 / $4,201.47 / $4,201.47
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,201.47 / $4,201.47 / $4,201.47
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,631.64 / $1,631.64 / $1,631.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.46 / $2,789.12 / $5,799.59