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Texas 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
$31.88 / $41.30 / $63.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.07 / $318.02 / $688.07
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$31.88 / $44.74 / $99.66
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$206.19 / $263.98 / $500.71
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.31 / $218.31 / $433.80
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$37.72 / $66.06 / $91.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.20 / $271.43 / $378.22
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.00 / $498.98 / $594.16
Christus
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.67 / $49.14 / $49.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.49 / $399.29 / $658.68
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.25 / $61.54 / $100.65
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$232.80 / $336.15 / $561.86
Lucent Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$118.60 / $242.96 / $242.96
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,348.14 / $2,348.14 / $2,851.13
Lucent Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$379.76 / $379.76 / $396.68
Lucent Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$2,034.68 / $2,034.68 / $2,454.38
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.86 / $541.17 / $826.89
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$68.36 / $85.45 / $191.48
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$400.01 / $500.01 / $1,120.48
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.73 / $337.84 / $399.07
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.38 / $418.69 / $692.00
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.21 / $65.31 / $103.15
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$239.26 / $353.26 / $589.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$293.11 / $353.65 / $561.85
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.02 / $52.90 / $79.48
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$248.34 / $302.58 / $496.03
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.93 / $311.86 / $445.62
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$40.86 / $47.16 / $65.04
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$239.07 / $264.70 / $380.58