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Idaho rates for HCPCS 79101

Radiopharmaceutical therapy, by intravenous administration

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$134.90 / $134.90 / $245.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $169.82 / $302.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$54.95 / $66.07 / $102.33
BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$489.78 / $489.78 / $489.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $269.15 / $338.84
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$81.28 / $95.50 / $109.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $234.42 / $275.42
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$61.66 / $81.28 / $93.33
Moda Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$134.90 / $134.90 / $134.90
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $251.19 / $398.11
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$87.10 / $93.33 / $147.91
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$489.78 / $489.78 / $489.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $295.12 / $302.00
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$95.50 / $107.15 / $109.65
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $134.90 / $407.38
Select Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$48.98 / $50.12 / $575.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $162.18 / $288.40
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$44.67 / $58.88 / $104.71