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Michigan 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
$687.76 / $733.38 / $1,144.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.04 / $916.73 / $1,157.97
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$514.29 / $514.29 / $541.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.29 / $541.36 / $730.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.00 / $940.81 / $1,176.01
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$733.38 / $733.38 / $1,347.59
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.10 / $741.10 / $926.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.23 / $463.19 / $490.98