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Utah 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
$1,023.29 / $1,698.24 / $3,715.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,456.54 / $6,456.54 / $6,456.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $60.26 / $60.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $4,570.88 / $4,570.88
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,801.89 / $3,801.89 / $5,495.41
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,265.80 / $4,786.30 / $6,025.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,148.15 / $3,235.94