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Upper GI X-Ray Series

New Hampshire rates for HCPCS 74240

This is an X-ray study of the stomach and upper small intestine, taken after the patient swallows a contrast liquid that coats the lining of the digestive tract so it shows up clearly on the images. It is used to look for ulcers, narrowing, abnormal contractions, or other structural problems.

Rates data updated July 2026.

Facilitymedian $48 · 10th–90th $34$1290%20%10th90th$48Professionalmedian $105 · 10th–90th $42$2510%5%10th90th$105$50.0$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
26 · Professional part
Typical Low
$33.88
Median
$63.10
Typical High
$128.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$112.20
Typical High
$194.98
Aetna
Setting
Professional
Modifier
26 · Professional part
Typical Low
$25.70
Median
$33.88
Typical High
$64.57
Aetna
Setting
Professional
Modifier
TC · Technical part
Typical Low
$61.66
Median
$77.62
Typical High
$134.90
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$194.98
Typical High
$257.04
Anthem BCBS
Setting
Professional
Modifier
26 · Professional part
Typical Low
$38.02
Median
$58.88
Typical High
$81.28
Anthem BCBS
Setting
Professional
Modifier
TC · Technical part
Typical Low
$85.11
Median
$131.83
Typical High
$177.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$186.21
Typical High
$331.13
Cigna
Setting
Professional
Modifier
26 · Professional part
Typical Low
$38.90
Median
$57.54
Typical High
$102.33
Cigna
Setting
Professional
Modifier
TC · Technical part
Typical Low
$72.44
Median
$128.82
Typical High
$251.19
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$218.78
Typical High
$323.59
Harvard Pilgrim
Setting
Professional
Modifier
26 · Professional part
Typical Low
$43.65
Median
$66.07
Typical High
$100.00
Harvard Pilgrim
Setting
Professional
Modifier
TC · Technical part
Typical Low
$97.72
Median
$151.36
Typical High
$223.87
United
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$190.55
Typical High
$416.87
United
Setting
Professional
Modifier
26 · Professional part
Typical Low
$41.69
Median
$58.88
Typical High
$114.82
United
Setting
Professional
Modifier
TC · Technical part
Typical Low
$85.11
Median
$123.03
Typical High
$257.04
Well Sense
Setting
Facility
Modifier
26 · Professional part
Typical Low
$28.18
Median
$30.90
Typical High
$38.02