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Montana 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
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,119.36 / $1,119.36 / $1,119.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$887.12 / $1,108.91 / $1,119.36
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,119.36 / $1,119.36 / $1,119.36
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$694.78 / $694.78 / $1,119.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.23 / $324.23 / $771.98