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Nebraska rates for HCPCS 78264

Gastric Emptying Imaging Study

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$35.49 / $120.13 / $325.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.83 / $731.28 / $1,974.28
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$35.49 / $81.34 / $195.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$250.35 / $250.35 / $1,754.27
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$642.60 / $642.60 / $642.60
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.90 / $70.30 / $88.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$517.73 / $553.39 / $567.23
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$64.81 / $69.28 / $71.01
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$452.92 / $484.12 / $496.22
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$204.42 / $204.42 / $204.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$560.69 / $699.68 / $874.60
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.18 / $83.78 / $104.72
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$490.51 / $615.91 / $769.88
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$168.00 / $168.00 / $168.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.39 / $600.26 / $782.70
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.60 / $74.09 / $110.51
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$330.10 / $530.74 / $687.70
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$121.15 / $124.68 / $204.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.45 / $653.70 / $797.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.70 / $603.30 / $773.77
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.60 / $73.23 / $95.00
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$330.10 / $525.73 / $668.72