go back

Hawaii 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
$636.88 / $721.80 / $926.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$926.38 / $926.38 / $926.38
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$687.11 / $808.36 / $964.98
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$771.98 / $926.38 / $1,157.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.23 / $926.38 / $1,157.97