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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
$1,318.26 / $1,621.81 / $2,344.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,495.41 / $5,495.41 / $5,495.41
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,495.41 / $5,495.41 / $5,495.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,148.15 / $24,547.09