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South Carolina rates for HCPCS G0279

Diagnostic Digital Breast Tomosynthesis Unilateral Or Bilateral (List Separately In Addition To 77065 Or 77067) (Code Reinstated 01012015) (Desc Revised 1/1/2018) Extracorporeal Shock Wave Therapy; Involving Elbowepicondylitis (Eff. 01012003 - Delted 12312005)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$29.80 / $37.26 / $42.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.72 / $53.30 / $139.41
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.82 / $29.81 / $69.70
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$19.88 / $23.48 / $39.24
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $33.11 / $43.62
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$21.63 / $40.61 / $47.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.58 / $54.39 / $76.45
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$26.70 / $30.71 / $42.73
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$13.88 / $23.52 / $32.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.28 / $39.28 / $39.28
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.29 / $25.29 / $25.29
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$13.99 / $13.99 / $13.99
Medcost
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$29.65 / $29.87 / $82.14
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.30 / $189.30 / $189.30
Medcost
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$106.57 / $106.57 / $106.57
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.11 / $64.71 / $102.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.46 / $65.55 / $106.29
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.23 / $36.82 / $58.30
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$22.91 / $28.64 / $47.52