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Maryland 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
$100.00 / $100.00 / $141.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,148.15 / $3,311.31
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$112.20 / $218.78 / $660.69
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$275.42 / $891.25 / $1,479.11
Aetna
Facility/Professional
Professional
Modifier
53
Low / Median / High Price
$398.11 / $549.54 / $549.54
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$616.60 / $776.25 / $1,698.24
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $776.25 / $954.99
CareFirst
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.71 / $117.49 / $181.97
CareFirst
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$676.08 / $676.08 / $870.96
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$177.83 / $177.83 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,071.52 / $2,041.74
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.15 / $190.55 / $331.13
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$575.44 / $891.25 / $1,659.59
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $977.24 / $1,288.25
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$123.03 / $134.90 / $213.80
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$724.44 / $831.76 / $1,096.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,071.52 / $1,778.28
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$112.20 / $173.78 / $275.42
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$616.60 / $870.96 / $1,513.56
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $977.24 / $1,258.93
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$112.20 / $141.25 / $177.83
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$616.60 / $851.14 / $1,096.48