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Missouri 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
$59.05 / $64.91 / $154.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.44 / $464.36 / $1,974.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$59.05 / $66.92 / $236.49
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$327.39 / $398.08 / $852.07
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$49.81 / $85.94 / $106.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$443.07 / $493.26 / $908.94
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.90 / $75.56 / $134.52
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$372.17 / $420.27 / $774.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.60 / $664.30 / $869.79
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$59.17 / $100.19 / $141.49
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$316.76 / $558.42 / $735.88
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$160.18 / $301.25 / $301.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.61 / $597.17 / $2,608.01
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$65.18 / $88.15 / $388.97
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$369.03 / $503.48 / $2,219.04
Qualchoice
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$122.46 / $122.46 / $122.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.61 / $598.32 / $1,000.08
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$65.02 / $86.91 / $159.60
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$369.03 / $503.48 / $840.48