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California rates for HCPCS 91110

Gi Trc Img Intraluminal Esophagus-Ileum W/I&R

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$187.33 / $207.78 / $759.55
Aetna
Facility/Professional
Facility
Modifier
53
Low / Median / High Price
$190.92 / $226.56 / $1,170.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$785.61 / $1,132.80 / $4,569.96
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$120.66 / $207.93 / $808.39
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$335.54 / $435.54 / $2,346.23
Aetna
Facility/Professional
Professional
Modifier
53
Low / Median / High Price
$134.22 / $173.41 / $801.68
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$618.97 / $790.14 / $1,526.40
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.57 / $512.57 / $512.57
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$84.57 / $121.23 / $121.23
Ambetter
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$128.13 / $128.13 / $128.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$795.37 / $1,174.10 / $2,306.50
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$137.87 / $242.28 / $450.93
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$627.20 / $936.88 / $1,915.62
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.36 / $995.94 / $2,378.83
Blue Shield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$131.30 / $202.22 / $453.94
Blue Shield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$470.06 / $778.49 / $1,909.33
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$126.71 / $126.71 / $126.71
Cigna
Facility/Professional
Facility
Modifier
53
Low / Median / High Price
$163.30 / $163.30 / $163.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$865.44 / $1,195.00 / $2,567.62
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$135.43 / $210.37 / $374.32
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$707.46 / $981.76 / $2,153.02
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$804.29 / $932.66 / $1,259.08
Contra Costa Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$120.64 / $138.16 / $175.84
Contra Costa Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$683.65 / $807.06 / $1,089.53
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.35 / $904.81 / $1,619.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$109.91 / $150.72 / $236.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$645.65 / $932.58 / $1,512.34
Lucent Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$259.19 / $789.30 / $789.30
Lucent Health
Facility/Professional
Facility
Modifier
53
Low / Median / High Price
$250.59 / $754.92 / $754.92
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,332.25 / $5,492.22 / $5,862.60
Lucent Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$942.99 / $1,044.83 / $1,044.83
Lucent Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$4,416.72 / $4,549.22 / $4,976.85
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $829.65
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$126.71 / $126.71 / $126.71
Providence
Facility/Professional
Facility
Modifier
53
Low / Median / High Price
$163.30 / $163.30 / $163.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$906.07 / $1,382.76 / $2,302.94
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$137.46 / $212.53 / $362.28
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$721.44 / $986.56 / $2,153.02
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,911.59 / $2,911.59 / $2,911.59
Sutter Health Plus
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$422.49 / $422.49 / $422.49
Sutter Health Plus
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$2,489.10 / $2,489.10 / $2,489.10
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$754.46 / $1,037.39 / $1,530.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$703.60 / $999.16 / $2,313.34
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$109.80 / $176.50 / $357.00
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$589.53 / $837.20 / $1,939.03