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Vermont rates for HCPCS 0120U

Oncology (B-cell lymphoma classification), mRNA, gene expression profiling by fluorescent probe hybridization of 58 genes (45 content and 13 housekeeping genes), formalin-fixed paraffin-embedded tissue, algorithm reported as likelihood for primary mediastinal B-cell lymphoma (PMBCL) and diffuse large B-cell lymphoma (DLBCL) with cell of origin subtyping in the latter

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,137.96 / $3,090.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,168.69 / $4,168.69 / $4,168.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $2,511.89
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $2,511.89
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $2,511.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $2,818.38 / $5,754.40