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Indiana 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
$106.21 / $106.22 / $112.65
Aetna
Facility/Professional
Facility
Modifier
53
Low / Median / High Price
$137.60 / $137.60 / $137.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$671.08 / $804.13 / $1,365.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$105.76 / $113.20 / $207.93
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$335.54 / $361.16 / $463.33
Aetna
Facility/Professional
Professional
Modifier
53
Low / Median / High Price
$134.22 / $144.46 / $190.92
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$564.08 / $653.48 / $836.52
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$815.97 / $941.51 / $1,004.27
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$109.83 / $154.83 / $154.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$738.71 / $896.40 / $1,272.88
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$150.53 / $177.10 / $251.48
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$575.52 / $719.40 / $1,021.54
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.38 / $573.85 / $795.77
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
$753.10 / $1,015.18 / $1,779.35
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$116.15 / $196.93 / $371.76
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$628.59 / $813.78 / $1,402.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$765.17 / $945.42 / $1,613.34
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$125.49 / $183.77 / $274.68
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$635.29 / $772.67 / $1,215.94