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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
Facility
Modifier
Low / Median / High Price
$537.03 / $870.96 / $870.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $588.84 / $891.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $1,479.11 / $1,479.11
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
$724.44 / $870.96 / $3,630.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $398.11 / $933.25
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,819.70 / $2,137.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $467.74 / $1,023.29
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $776.25 / $776.25