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Nebraska 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
$1,548.82 / $2,041.74 / $3,801.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $588.84 / $724.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,148.15 / $2,238.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $1,174.90 / $1,258.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,479.11 / $1,862.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $912.01 / $3,630.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $467.74 / $851.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $691.83 / $1,148.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $467.74 / $851.14