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Louisiana 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
$1,138.20 / $2,010.82 / $2,466.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$584.16 / $805.88 / $805.88
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,435.00 / $5,435.00 / $5,435.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$796.74 / $1,138.20 / $3,794.00