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Illinois 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
Facility
Modifier
Low / Median / High Price
$14,791.08 / $14,791.08 / $14,791.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,548.82 / $3,715.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,309.57 / $6,606.93 / $7,943.28
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,801.89 / $6,760.83 / $11,481.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,148.15 / $2,290.87