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Montana 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
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,880.75 / $7,880.75 / $7,880.75
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,371.25 / $6,522.00 / $7,880.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$796.74 / $796.74 / $1,897.00