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Idaho rates for HCPCS 0295U

Oncology (breast ductal carcinoma in situ), protein expression profiling by immunohistochemistry of 7 proteins (COX2, FOXA1, HER2, Ki-67, p16, PR, SIAH2), with 4 clinicopathologic factors (size, age, margin status, palpability), utilizing formalin-fixed paraffin-embedded (FFPE) tissue, algorithm reported as a recurrence risk score

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,699.15 / $3,699.15 / $3,699.15
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,699.15 / $4,069.07 / $8,152.50
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,435.00 / $6,522.00 / $6,793.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $10,598.25
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,122.68 / $8,122.68 / $8,394.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$796.74 / $796.74 / $2,181.55