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Wisconsin rates for HCPCS 78815

Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; skull base to mid-thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$100.00 / $169.82 / $234.42
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.00 / $151.36 / $831.76
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$109.65 / $169.82 / $645.65
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$295.12 / $346.74 / $549.54
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$169.82 / $398.11 / $457.09
DeanCare
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$223.87 / $263.03 / $316.23
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$1,479.11 / $1,479.11 / $1,479.11
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$123.03 / $251.19 / $1,202.26
Quartz
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$263.03 / $1,023.29 / $1,023.29
Quartz
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$162.18 / $588.84 / $1,202.26
Security Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$229.09 / $288.40 / $7,585.78
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$120.23 / $229.09 / $501.19