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Texas 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
$583.62 / $1,352.51 / $3,790.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$463.19 / $578.99 / $625.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$771.98 / $771.98 / $771.98
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$771.98 / $771.98 / $771.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$496.31 / $1,535.48 / $3,439.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.15 / $940.81 / $1,176.01
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,235.17 / $3,666.91 / $3,666.91
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $771.98 / $849.18
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$694.78 / $771.98 / $771.98
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.58 / $771.98 / $1,073.05
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$594.41 / $733.38 / $810.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.23 / $324.23 / $463.19
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.79 / $308.79 / $771.98