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Ohio 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
$48.31 / $79.94 / $171.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.73 / $357.47 / $677.59
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.85 / $53.40 / $108.59
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$271.31 / $308.92 / $575.17
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.80 / $241.80 / $241.80
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$65.67 / $77.75 / $77.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.62 / $321.38 / $530.02
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$54.95 / $62.47 / $99.66
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$206.67 / $250.07 / $431.94
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.60 / $280.89 / $332.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.26 / $448.44 / $813.48
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$47.77 / $66.68 / $115.95
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$256.26 / $380.33 / $690.62
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.08 / $445.01 / $777.56
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.27 / $73.02 / $140.15
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$263.52 / $380.33 / $665.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.05 / $335.51 / $490.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.59 / $401.32 / $725.73
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.87 / $59.03 / $170.26
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$210.30 / $344.97 / $660.35