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Wisconsin rates for HCPCS 91113

Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), colon, with interpretation and report

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $977.24 / $3,162.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $954.99 / $1,230.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,318.26 / $3,235.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $2,884.03 / $4,570.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $2,238.72 / $3,090.30
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $1,000.00 / $1,778.28
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,862.09 / $2,454.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $1,023.29 / $2,398.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,737.80 / $5,888.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $2,290.87 / $3,235.94
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $5,888.44 / $5,888.44
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $3,548.13 / $5,888.44
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,122.02
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $4,570.88 / $5,623.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $2,454.71 / $3,235.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,584.89 / $3,311.31