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Wisconsin rates for HCPCS 78264

Gastric Emptying Imaging Study

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$55.63 / $55.63 / $77.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.48 / $459.47 / $1,793.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.20 / $55.63 / $348.50
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$218.71 / $299.66 / $488.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.43 / $491.78 / $1,671.21
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$35.89 / $56.65 / $200.47
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$260.54 / $435.13 / $1,470.74
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$96.42 / $109.57 / $172.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$424.95 / $1,058.64 / $1,203.00
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.23 / $128.88 / $146.44
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$371.72 / $929.75 / $1,056.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.88 / $631.92 / $2,023.55
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.03 / $84.55 / $267.48
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$271.27 / $552.79 / $1,789.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $244.53 / $564.07
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$428.76 / $700.45 / $1,008.41
Quartz
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$168.00 / $168.00 / $168.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$445.88 / $1,628.45 / $2,023.55
Quartz
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$54.28 / $192.25 / $267.48
Quartz
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$391.60 / $1,436.25 / $1,789.49
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$803.39 / $1,886.39 / $1,886.39
Security Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$102.16 / $129.26 / $211.56
Security Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$671.93 / $790.50 / $1,429.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.88 / $592.42 / $1,427.34
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.96 / $77.22 / $168.51
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$272.07 / $463.15 / $1,381.22