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Vermont 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 / $2,352.28
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,233.05 / $1,233.05 / $1,233.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$796.74 / $2,655.80 / $2,750.65