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Montana 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
Professional
Modifier
Low / Median / High Price
$588.84 / $724.44 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,122.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,096.48 / $1,122.02
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $954.99 / $2,344.23
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $954.99 / $2,344.23
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,122.02
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $691.83 / $954.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $323.59 / $776.25