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Alaska rates for HCPCS 78803

Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT), single area (eg, head, neck, chest, pelvis) or acquisition, single day imaging

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$157.24 / $157.24 / $157.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.73 / $393.21 / $1,024.18
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.85 / $53.40 / $173.17
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$272.87 / $339.81 / $851.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$909.56 / $909.56 / $1,155.11
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$160.76 / $160.76 / $185.80
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$748.80 / $748.80 / $969.32
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.98 / $983.97 / $1,774.50
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$119.68 / $143.61 / $154.13
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$700.30 / $840.36 / $901.99
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,226.25 / $1,406.70 / $1,855.62
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$185.00 / $199.80 / $270.83
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,041.25 / $1,206.90 / $1,584.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.98 / $1,302.50 / $2,294.14
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$177.60 / $223.50 / $335.90
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$969.32 / $1,444.50 / $1,958.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$482.84 / $834.86 / $1,386.15
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$73.75 / $146.80 / $222.96
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$409.09 / $688.06 / $1,163.19