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Montana rates for HCPCS 81504

Oncology (tissue of origin), microarray gene expression profiling of >2,000 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as tissue similarity scores

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$598.00 / $3,343.60 / $3,343.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$754.00 / $884.00 / $2,964.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$754.00 / $754.00 / $754.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$754.00 / $884.00 / $2,964.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.00 / $468.00 / $754.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.40 / $218.40 / $520.00