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Ohio 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
$724.44 / $1,148.15 / $1,862.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $630.96 / $977.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $467.74 / $1,230.27
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $537.03 / $891.25
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $12,022.64 / $21,379.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $501.19 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $891.25 / $1,096.48
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $794.33 / $1,621.81
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $501.19 / $501.19
SummaCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $933.25 / $933.25
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $812.83 / $1,548.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $501.19 / $776.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $467.74 / $776.25