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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
$1,707.30 / $1,707.30 / $1,707.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,522.00 / $6,522.00 / $6,522.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,627.92 / $6,253.24 / $7,538.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$796.74 / $796.74 / $1,138.20