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Washington rates for HCPCS 77063

Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$32.36 / $45.71 / $79.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $61.66 / $213.80
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.70 / $43.65 / $117.49
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$25.70 / $47.86 / $257.04
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$19.95 / $28.84 / $104.71
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $74.13 / $112.20
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$20.89 / $43.65 / $54.95
Ambetter
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$21.88 / $28.18 / $36.31
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$26.92 / $45.71 / $54.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $85.11 / $158.49
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.70 / $45.71 / $83.18
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$21.38 / $39.81 / $74.13
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$33.11 / $56.23 / $87.10
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $97.72 / $138.04
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.18 / $52.48 / $72.44
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$25.70 / $45.71 / $64.57
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $33.11
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$45.71 / $56.23 / $57.54
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.67 / $47.86 / $63.10
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$33.11 / $42.66 / $52.48
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$38.02 / $38.02 / $38.90
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $114.82 / $151.36
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.02 / $61.66 / $83.18
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$33.11 / $52.48 / $69.18
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$48.98 / $48.98 / $48.98
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $109.65 / $147.91
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.81 / $60.26 / $79.43
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$33.88 / $50.12 / $67.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $66.07 / $138.04
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.70 / $35.48 / $74.13
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$22.91 / $29.51 / $61.66
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $60.26 / $100.00
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.18 / $32.36 / $53.70
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$24.55 / $28.18 / $46.77