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Maryland 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
$1,233.05 / $1,233.05 / $1,555.54
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,517.60 / $1,517.60 / $4,348.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,005.41 / $1,005.41 / $1,005.41
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,435.00 / $6,250.25 / $8,152.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$796.74 / $905.63 / $2,445.75
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,717.50 / $2,717.50 / $2,717.50