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Texas 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
$86.08 / $102.75 / $125.81
Aetna
Facility/Professional
Facility
Modifier
53
Low / Median / High Price
$122.29 / $144.46 / $164.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$641.62 / $865.80 / $1,760.24
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.97 / $132.47 / $458.28
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$316.98 / $392.81 / $566.40
Aetna
Facility/Professional
Professional
Modifier
53
Low / Median / High Price
$126.79 / $157.12 / $226.56
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$533.63 / $700.56 / $1,108.33
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$449.76 / $514.01 / $815.35
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$73.39 / $89.11 / $129.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.42 / $555.55 / $1,177.91
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.00 / $748.48 / $1,188.64
Christus
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$115.49 / $129.02 / $129.02
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
$712.24 / $1,068.71 / $1,733.58
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$110.23 / $183.54 / $331.35
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$596.79 / $867.93 / $1,416.17
Lucent Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$259.19 / $789.30 / $789.30
Lucent Health
Facility/Professional
Facility
Modifier
53
Low / Median / High Price
$271.97 / $754.92 / $754.92
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,332.25 / $5,492.22 / $5,862.60
Lucent Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$942.99 / $1,044.83 / $1,044.83
Lucent Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$4,416.72 / $4,549.22 / $4,976.85
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$844.65 / $1,114.94 / $2,702.88
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$138.76 / $176.12 / $426.96
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$739.66 / $938.80 / $2,275.88
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.09 / $927.00 / $1,823.20
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$126.71 / $126.71 / $126.71
Providence
Facility/Professional
Facility
Modifier
53
Low / Median / High Price
$163.30 / $163.30 / $163.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$731.22 / $1,146.68 / $2,052.16
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$114.08 / $185.26 / $331.35
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$599.35 / $876.57 / $1,372.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$703.60 / $944.86 / $1,574.77
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$112.28 / $171.72 / $290.01
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$597.92 / $786.81 / $1,270.59
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$576.71 / $642.51 / $918.59
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$91.10 / $104.84 / $145.16
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$485.60 / $537.67 / $773.44