go back

New Hampshire 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
$1,327.90 / $1,327.90 / $1,536.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,549.20 / $3,532.75 / $3,532.75
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,435.00 / $5,435.00 / $5,435.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.80 / $1,138.20 / $3,261.00
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $2,750.00 / $3,500.00