go back

Pennsylvania 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
$1,023.29 / $2,089.30 / $3,162.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $630.96 / $851.14
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $602.56 / $602.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $1,202.26 / $2,630.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $1,096.48
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $457.09 / $1,122.02
Geisinger
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $776.25 / $776.25
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $776.25 / $1,348.96
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,949.84 / $3,162.28
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $630.96 / $1,949.84
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $851.14 / $851.14
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $851.14 / $851.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $776.25 / $933.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $467.74 / $1,148.15