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Swallowed Capsule Camera Bowel Exam

New Hampshire rates for HCPCS 91110

This test uses a small swallowable capsule containing a camera that takes pictures as it travels through the esophagus, stomach, and small intestine. The images are transmitted to a recorder worn by the patient and later reviewed by a doctor to look for sources of bleeding, inflammation, or other abnormalities in areas that are hard to reach with a standard scope.

Facilitymedian $282 · 10th–90th $200$6030%20%10th90th$282Professionalmedian $776 · 10th–90th $141$1,7380%5%10th90th$776$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
26 · Professional part
Typical Low
$199.53
Median
$281.84
Typical High
$602.56
Aetna
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$954.99
Typical High
$2,041.74
Aetna
Setting
Professional
Modifier
26 · Professional part
Typical Low
$107.15
Median
$181.97
Typical High
$371.54
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$245.47
Median
$245.47
Typical High
$1,071.52
Aetna
Setting
Professional
Modifier
TC · Technical part
Typical Low
$616.60
Median
$758.58
Typical High
$1,479.11
Ambetter
Setting
Professional
Modifier
26 · Professional part
Typical Low
$389.05
Median
$389.05
Typical High
$389.05
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$1,202.26
Typical High
$1,698.24
Anthem BCBS
Setting
Professional
Modifier
26 · Professional part
Typical Low
$117.49
Median
$186.21
Typical High
$263.03
Anthem BCBS
Setting
Professional
Modifier
TC · Technical part
Typical Low
$691.83
Median
$1,000.00
Typical High
$1,445.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$1,288.25
Typical High
$2,137.96
Cigna
Setting
Professional
Modifier
26 · Professional part
Typical Low
$123.03
Median
$208.93
Typical High
$363.08
Cigna
Setting
Professional
Modifier
TC · Technical part
Typical Low
$660.69
Median
$1,023.29
Typical High
$1,778.28
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$933.25
Median
$1,445.44
Typical High
$2,238.72
Harvard Pilgrim
Setting
Professional
Modifier
26 · Professional part
Typical Low
$134.90
Median
$213.80
Typical High
$323.59
Harvard Pilgrim
Setting
Professional
Modifier
TC · Technical part
Typical Low
$794.33
Median
$1,230.27
Typical High
$1,862.09
United
Setting
Professional
Modifier
Global
Typical Low
$891.25
Median
$1,548.82
Typical High
$2,884.03
United
Setting
Professional
Modifier
26 · Professional part
Typical Low
$131.83
Median
$234.42
Typical High
$426.58
United
Setting
Professional
Modifier
TC · Technical part
Typical Low
$758.58
Median
$1,288.25
Typical High
$2,344.23
Well Sense
Setting
Facility
Modifier
26 · Professional part
Typical Low
$83.18
Median
$91.20
Typical High
$123.03