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Louisiana 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
$818.30 / $1,113.97 / $4,060.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$578.99 / $856.90 / $1,003.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$835.90 / $1,507.60 / $2,375.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.93 / $31.08 / $38.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$807.89 / $1,480.69 / $5,452.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.15 / $887.12 / $1,108.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.79 / $385.99 / $1,157.97