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Idaho rates for HCPCS 76873

Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$204.17 / $204.17 / $204.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $186.21 / $323.59
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$57.54 / $75.86 / $354.81
BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$213.80 / $213.80 / $213.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $323.59 / $380.19
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$123.03 / $144.54 / $162.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $263.03 / $457.09
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.13 / $117.49 / $162.18
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $467.74 / $512.86
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$263.03 / $316.23 / $316.23
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $323.59 / $398.11
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.62 / $138.04 / $169.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $114.82
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$213.80 / $213.80 / $213.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $331.13 / $380.19
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$102.33 / $147.91 / $162.18
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $165.96 / $354.81
Select Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$72.44 / $72.44 / $154.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $186.21 / $354.81
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$75.86 / $81.28 / $151.36