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Arizona 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
$69.44 / $154.66 / $209.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.73 / $384.10 / $1,899.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.85 / $51.67 / $247.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$272.87 / $308.92 / $661.97
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.73 / $294.73 / $320.36
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.36 / $66.36 / $66.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.79 / $394.39 / $1,910.34
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$37.10 / $49.47 / $239.63
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$258.69 / $344.92 / $1,670.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.77 / $429.98 / $691.41
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.09 / $65.56 / $105.89
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$253.68 / $369.95 / $585.52
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$118.60 / $236.00 / $236.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$293.11 / $341.12 / $2,348.14
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.40 / $50.04 / $379.76
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$248.34 / $295.42 / $2,034.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$293.11 / $341.12 / $735.93
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.40 / $50.08 / $99.11
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$248.34 / $295.42 / $556.08