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Utah 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
$691.83 / $3,715.35 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $616.60 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $676.08 / $2,137.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $1,096.48
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $44.67
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $933.25 / $3,630.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $660.69 / $691.83
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $776.25 / $2,238.72
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $676.08 / $1,148.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $389.05 / $501.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $323.59 / $616.60