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Alaska rates for HCPCS 0095U

Eosinophilic esophagitis, 2 protein biomarkers (Eotaxin-3 [CCL26 {C-C motif chemokine ligand 26}] and Major Basic Protein [PRG2 {proteoglycan 2, pro eosinophil major basic protein}]), enzyme-linked immunosorbent assays (ELISA), specimen obtained by esophageal string test device, algorithm reported as probability of active or inactive eosinophilic esophagitis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $6,025.60 / $9,549.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $724.44 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $2,137.96 / $2,137.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $1,096.48
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $776.25 / $3,467.37
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,412.54 / $2,511.89
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,884.03 / $3,090.30
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,737.80 / $1,737.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $602.56 / $1,412.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $776.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $1,548.82 / $2,344.23