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New Hampshire 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
Facility
Modifier
Low / Median / High Price
$724.44 / $1,318.26 / $3,630.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $407.38 / $645.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,000.00 / $3,019.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $338.84 / $338.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $1,621.81 / $2,290.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $549.54 / $2,137.96
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $1,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $794.33