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New Hampshire 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
$608.72 / $608.72 / $608.72
Aetna
Facility/Professional
Facility
Modifier
53
Low / Median / High Price
$566.54 / $566.54 / $566.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$781.70 / $964.02 / $2,653.78
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$162.72 / $200.31 / $520.77
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$390.85 / $463.56 / $549.72
Aetna
Facility/Professional
Professional
Modifier
53
Low / Median / High Price
$156.34 / $185.42 / $219.89
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$657.97 / $763.71 / $2,132.98
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$353.90 / $353.90 / $353.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$675.72 / $1,149.01 / $1,671.19
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$106.74 / $178.35 / $264.00
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$568.97 / $962.87 / $1,407.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$797.32 / $1,441.47 / $2,151.64
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$123.33 / $226.61 / $372.38
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$673.99 / $1,223.19 / $1,729.69
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$806.13 / $1,477.42 / $2,548.17
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$122.20 / $211.38 / $402.54
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$651.36 / $1,126.72 / $2,145.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,105.03 / $1,751.72 / $2,989.10
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$132.09 / $223.26 / $434.32
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$747.41 / $1,203.23 / $2,530.44
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$712.69 / $855.23 / $1,234.39
Well Sense
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$99.56 / $139.38 / $218.84
Well Sense
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$595.88 / $714.24 / $1,028.14