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Michigan rates for HCPCS 78830

Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT) with concurrently acquired computed tomography (CT) transmission scan for anatomical review, localization and determination/detection of pathology, single area (eg, head, neck, chest, pelvis) or acquisition, single day imaging

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$79.89 / $79.89 / $83.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$463.49 / $502.24 / $725.20
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$64.28 / $79.89 / $177.41
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$399.20 / $422.35 / $622.12
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.35 / $85.11 / $138.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.10 / $535.83 / $706.23
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$105.99 / $105.99 / $105.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$368.85 / $826.49 / $1,187.47
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$49.97 / $80.62 / $149.27
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$399.14 / $747.92 / $1,028.75
Health Alliance Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$56.73 / $79.89 / $81.31
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.30 / $463.49 / $654.92
Health Alliance Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.73 / $74.58 / $180.18
Health Alliance Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$328.56 / $410.70 / $633.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.47 / $357.20 / $470.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$451.33 / $525.04 / $693.22
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.45 / $79.62 / $105.80
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$384.88 / $448.29 / $648.48