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Wisconsin rates for HCPCS 79101

Radiopharmaceutical therapy, by intravenous administration

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$141.25 / $141.25 / $194.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $151.36 / $331.13
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$39.81 / $56.23 / $117.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $218.78 / $776.25
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$48.98 / $79.43 / $275.42
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$245.47 / $288.40 / $457.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $467.74 / $602.56
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$75.86 / $165.96 / $218.78
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $338.84 / $407.38
DeanCare
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$107.15 / $123.03 / $151.36
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $354.81 / $1,148.15
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$56.23 / $125.89 / $588.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $162.18
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $338.84 / $630.96
Quartz
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$218.78 / $588.84 / $588.84
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $724.44 / $1,148.15
Quartz
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$87.10 / $331.13 / $602.56
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $891.25 / $1,122.02
Security Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$144.54 / $158.49 / $281.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $263.03 / $645.65
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$52.48 / $97.72 / $213.80