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New Hampshire 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
$1,949.84 / $1,949.84 / $5,370.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $537.03 / $630.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $1,479.11 / $4,466.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $501.19 / $562.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $2,398.83 / $3,388.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $1,096.48
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,348.96 / $2,454.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $467.74 / $1,174.90