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Wisconsin 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
$26.92 / $42.66 / $60.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $79.43 / $208.93
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$26.30 / $53.70 / $125.89
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$26.30 / $48.98 / $134.90
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$19.95 / $37.15 / $109.65
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $72.44 / $234.42
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$27.54 / $39.81 / $128.82
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$22.91 / $34.67 / $107.15
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $37.15 / $77.62
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$79.43 / $89.13 / $138.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $112.20 / $213.80
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.20 / $60.26 / $114.82
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$23.99 / $51.29 / $97.72
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $114.82 / $158.49
DeanCare
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.48 / $63.10 / $85.11
DeanCare
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$44.67 / $52.48 / $72.44
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$31.62 / $128.82 / $128.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $100.00 / $331.13
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.88 / $54.95 / $147.91
Medica
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$41.69 / $72.44 / $74.13
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$26.30 / $42.66 / $151.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $74.13
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $120.23 / $181.97
Quartz
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$66.07 / $181.97 / $181.97
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $269.15 / $331.13
Quartz
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$35.48 / $147.91 / $181.97
Quartz
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$30.90 / $120.23 / $151.36
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $147.91 / $331.13
Security Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$61.66 / $72.44 / $93.33
Security Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$50.12 / $60.26 / $83.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $83.18 / $194.98
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.90 / $45.71 / $107.15
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$25.12 / $38.02 / $87.10