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Massachusetts 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
$15,337.60 / $15,337.60 / $15,337.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,261.51 / $1,403.78 / $1,536.57
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25,816.25 / $25,816.25 / $25,816.25
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,138.20 / $2,181.55 / $27,066.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,620.11 / $6,620.11 / $7,931.64
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,842.29 / $7,842.29 / $9,226.21
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,435.00 / $5,435.00 / $5,435.00
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25,816.25 / $25,816.25 / $25,816.25
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,138.20 / $2,181.55 / $27,066.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,138.20 / $1,138.20 / $5,435.00