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South Dakota 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
$540.39 / $540.39 / $540.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,539.30 / $1,539.30 / $1,539.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$896.00 / $1,402.21 / $1,752.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$728.60 / $874.12 / $3,666.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.71 / $694.78 / $1,157.97
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$926.38 / $1,411.76 / $1,519.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$927.15 / $1,519.19 / $2,014.87
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$771.98 / $1,859.93 / $2,120.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.23 / $463.19 / $926.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$771.98 / $771.98 / $771.98