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Michigan 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
$6,152.00 / $6,152.00 / $6,152.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,620.73 / $4,001.85 / $5,145.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,311.96 / $2,311.96 / $2,889.96
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,487.46 / $9,487.46 / $9,487.46
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,821.12 / $1,821.12 / $6,152.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$796.74 / $1,138.20 / $1,897.00