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Wyoming 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
$47.67 / $47.67 / $48.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.58 / $327.58 / $375.33
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.84 / $50.84 / $50.84
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$279.92 / $279.92 / $324.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$907.00 / $907.00 / $1,492.00
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$126.00 / $126.00 / $208.00
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$781.00 / $781.00 / $1,284.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.61 / $460.61 / $945.79
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$69.30 / $69.30 / $135.81
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$391.31 / $391.31 / $809.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.60 / $689.45 / $1,190.81
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.06 / $102.18 / $166.11
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$257.20 / $577.80 / $994.50