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Washington 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
$162.18 / $251.19 / $512.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,047.13 / $3,981.07
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$109.65 / $208.93 / $812.83
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$154.88 / $1,071.52 / $1,479.11
Aetna
Facility/Professional
Professional
Modifier
53
Low / Median / High Price
$549.54 / $549.54 / $549.54
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$588.84 / $758.58 / $1,513.56
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $691.83 / $1,122.02
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$91.20 / $91.20 / $91.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,348.96 / $2,398.83
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$125.89 / $213.80 / $380.19
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$660.69 / $1,122.02 / $2,041.74
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$162.18 / $263.03 / $2,238.72
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,513.56 / $2,089.30
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$147.91 / $245.47 / $331.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$776.25 / $1,288.25 / $1,778.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $398.11
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$181.97 / $218.78 / $354.81
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $489.78 / $489.78
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$158.49 / $275.42 / $354.81
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$831.76 / $1,122.02 / $1,548.82
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$151.36 / $151.36 / $151.36
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,584.89 / $2,137.96
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$151.36 / $251.19 / $323.59
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$870.96 / $1,318.26 / $1,819.70
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$1,584.89 / $1,584.89 / $1,584.89
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,513.56 / $1,949.84
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$154.88 / $218.78 / $323.59
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$933.25 / $1,288.25 / $1,659.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,288.25 / $2,187.76
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$131.83 / $229.09 / $354.81
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$691.83 / $1,071.52 / $1,819.70
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $977.24 / $1,584.89
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$120.23 / $138.04 / $229.09
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$724.44 / $831.76 / $1,380.38