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Missouri 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
$48.02 / $65.04 / $113.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.70 / $357.47 / $1,058.65
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.69 / $49.50 / $229.93
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$263.01 / $295.17 / $858.79
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.65 / $62.08 / $74.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.91 / $383.93 / $607.16
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.65 / $63.55 / $101.39
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$259.26 / $320.11 / $537.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.91 / $475.54 / $789.99
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.58 / $72.33 / $108.44
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$242.12 / $404.15 / $681.56
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
$328.55 / $466.91 / $2,348.14
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$49.65 / $65.33 / $379.76
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$280.51 / $389.57 / $2,034.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$328.55 / $441.86 / $766.74
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$47.62 / $64.68 / $163.29
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$284.62 / $376.20 / $657.51