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Louisiana rates for HCPCS 0017M

Oncology (diffuse large B-cell lymphoma [DLBCL]), mRNA, gene expression profiling by fluorescent probe hybridization of 20 genes, formalin-fixed paraffin-embedded tissue, algorithm reported as cell of origin

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $3,630.78 / $12,882.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $2,187.76 / $3,162.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $4,897.79 / $7,762.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $602.56 / $602.56
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $2,511.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $1,949.84 / $19,054.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $2,511.89 / $2,511.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,258.93 / $3,548.13