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Maine 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
$771.98 / $771.98 / $1,640.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$625.29 / $625.29 / $625.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.79 / $501.78 / $501.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$887.12 / $887.12 / $1,108.91
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$771.98 / $771.98 / $934.87
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$771.98 / $771.98 / $1,250.60
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$625.29 / $625.29 / $771.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$463.19 / $463.19 / $1,119.36