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Virginia 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
$575.44 / $1,479.11 / $1,905.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $588.84 / $741.31
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,090.30 / $4,073.80 / $4,786.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $512.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $1,513.56 / $3,981.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $891.25 / $1,096.48
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $933.25 / $1,148.15
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $616.60 / $891.25
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $630.96 / $1,621.81
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $870.96 / $1,949.84
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $870.96 / $1,621.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $776.25 / $933.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $346.74 / $575.44