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Pennsylvania 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
$6,639.50 / $7,834.61 / $7,834.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,005.41 / $1,536.57 / $1,612.45
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,239.30 / $4,239.30 / $4,239.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,522.00 / $6,522.00 / $9,042.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26,196.70 / $26,196.70 / $26,196.70
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,706.75 / $7,337.25 / $13,424.45
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,834.61 / $7,834.61 / $7,834.61
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,138.20 / $1,536.57 / $7,834.61
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,043.80 / $8,152.50 / $10,870.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,522.00 / $6,522.00 / $9,042.07
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26,196.70 / $26,196.70 / $26,196.70
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,897.00 / $1,897.00 / $1,897.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$796.74 / $1,138.20 / $5,435.00