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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
$7,762.47 / $7,762.47 / $13,489.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,412.54 / $1,621.81
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,265.80 / $4,265.80 / $4,265.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $9,120.11 / $9,120.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26,302.68 / $26,302.68 / $26,302.68
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,754.40 / $7,413.10 / $11,748.98
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $5,495.41 / $9,549.93
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,762.47 / $7,762.47 / $13,489.63
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,548.82 / $3,467.37
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,585.78 / $7,585.78 / $7,585.78
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $1,905.46 / $1,949.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,148.15 / $5,128.61