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Idaho 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
$1,380.38 / $1,380.38 / $1,995.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $724.44 / $1,513.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,445.44 / $2,754.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $776.25 / $831.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $1,621.81 / $3,019.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $891.25 / $1,096.48
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $776.25 / $1,513.56
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $812.83 / $933.25
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,513.56 / $2,754.23
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $812.83
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $776.25 / $776.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $323.59 / $933.25