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New Hampshire rates for HCPCS 0103U

Hereditary ovarian cancer (eg, hereditary ovarian cancer, hereditary endometrial cancer), genomic sequence analysis panel utilizing a combination of NGS, Sanger, MLPA, and array CGH, with mRNA analytics to resolve variants of unknown significance when indicated (24 genes [sequencing and deletion/duplication], EPCAM [deletion/duplication only])

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $12,302.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $912.01 / $1,380.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $2,137.96 / $10,000.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $1,122.02 / $1,659.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $5,495.41 / $7,585.78
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $3,311.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $676.08 / $1,737.80