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Maine 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
$135.00 / $135.00 / $135.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$844.53 / $964.02 / $1,280.89
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$135.00 / $187.33 / $228.77
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$390.85 / $453.13 / $482.01
Aetna
Facility/Professional
Professional
Modifier
53
Low / Median / High Price
$156.34 / $181.25 / $192.80
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$722.96 / $771.25 / $1,018.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$781.83 / $968.42 / $1,392.53
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$106.74 / $144.84 / $209.83
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$664.02 / $830.54 / $1,182.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$926.50 / $1,278.88 / $1,775.49
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$134.31 / $212.62 / $308.32
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$752.75 / $1,094.44 / $1,524.05
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.09 / $1,036.19 / $1,869.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$136.03 / $163.69 / $295.29
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$725.06 / $872.51 / $1,573.96
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$843.40 / $927.12 / $1,280.89
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$135.00 / $172.54 / $228.77
Martin's Point
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$390.85 / $453.13 / $482.01
Martin's Point
Facility/Professional
Professional
Modifier
53
Low / Median / High Price
$156.34 / $181.25 / $192.80
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$716.88 / $771.25 / $1,108.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$879.50 / $1,446.27 / $1,625.01
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$132.09 / $261.23 / $326.52
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$728.13 / $986.87 / $1,573.96