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Vermont 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
$364.00 / $364.00 / $3,343.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.35 / $870.35 / $870.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,168.47 / $1,168.47 / $1,168.47
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.35 / $870.35 / $870.35
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.00 / $200.00 / $1,168.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.14 / $520.00 / $2,340.00