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Alaska rates for HCPCS 91110

Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus through ileum, with interpretation and report

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$316.23 / $316.23 / $316.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,047.13 / $2,238.72
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$134.90 / $162.18 / $416.87
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$616.60 / $870.96 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,862.09 / $2,570.40
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$186.21 / $389.05 / $446.68
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$630.96 / $1,445.44 / $2,187.76
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $2,137.96 / $3,162.28
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$199.53 / $354.81 / $562.34
Moda Health
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$1,479.11 / $1,479.11 / $1,479.11
Moda Health
Facility/Professional
Professional
Modifier
53
Low / Median / High Price
$549.54 / $549.54 / $549.54
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,122.02 / $1,819.70 / $2,630.27
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $3,019.95 / $4,570.88
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$446.68 / $478.63 / $707.95
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$2,344.23 / $2,511.89 / $3,890.45
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,819.70 / $2,238.72
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$109.65 / $186.21 / $446.68
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$630.96 / $1,023.29 / $2,089.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,137.96 / $4,677.35
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$281.84 / $371.54 / $870.96
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,621.81 / $1,778.28 / $3,890.45