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Washington rates for HCPCS 78469

Myocardial imaging, infarct avid, planar; tomographic SPECT with or without quantification

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$48.63 / $94.52 / $155.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.85 / $269.01 / $650.16
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$166.21 / $220.38 / $526.15
Asuris Northwest Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$57.58 / $100.00 / $949.44
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.60 / $490.74 / $1,396.18
Asuris Northwest Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$231.46 / $390.70 / $1,165.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.95 / $481.02 / $718.51
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$244.91 / $391.51 / $579.32
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$41.85 / $106.33 / $2,377.71
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.67 / $545.37 / $687.18
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$192.82 / $435.61 / $559.67
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.31 / $232.19 / $468.46
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$63.21 / $84.42 / $88.43
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$214.00 / $303.26 / $367.62
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$57.58 / $57.58 / $57.98
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.04 / $474.04 / $577.38
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$254.80 / $379.26 / $460.51
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$949.44 / $949.44 / $4,053.27
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.60 / $432.54 / $617.12
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$272.39 / $347.10 / $499.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.02 / $242.14 / $591.86
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$156.76 / $192.66 / $503.19