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Virginia 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
$44.06 / $78.42 / $156.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.51 / $328.49 / $676.61
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.06 / $47.17 / $105.17
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$263.33 / $283.13 / $590.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.63 / $397.26 / $561.64
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.49 / $57.02 / $79.76
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$251.06 / $340.83 / $481.86
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$376.89 / $790.47 / $1,195.07
CareFirst
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.89 / $53.89 / $67.36
CareFirst
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$283.99 / $323.00 / $403.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$287.55 / $461.32 / $738.90
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$40.34 / $70.19 / $110.06
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$238.76 / $394.80 / $646.32
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$332.99 / $463.38 / $477.73
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.44 / $62.72 / $65.34
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$284.55 / $400.64 / $407.50
Medcost
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$58.24 / $77.13 / $91.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.00 / $426.00 / $636.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.73 / $410.77 / $2,213.00
Sentara
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$55.94 / $71.30 / $111.13
Sentara
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$287.68 / $442.56 / $747.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.19 / $483.20 / $824.71
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.78 / $69.36 / $107.15
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$275.33 / $413.11 / $628.51