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Pennsylvania 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
$65.53 / $85.84 / $207.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$399.15 / $493.74 / $1,974.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$57.16 / $70.55 / $261.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$335.94 / $399.56 / $676.14
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.40 / $109.86 / $126.38
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.97 / $541.80 / $792.59
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.98 / $84.53 / $119.77
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$342.00 / $457.28 / $672.82
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$76.76 / $76.76 / $76.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.38 / $559.01 / $877.32
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.98 / $80.54 / $132.91
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$303.39 / $476.91 / $755.78
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$597.13 / $597.13 / $664.39
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$87.51 / $87.51 / $97.34
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$509.61 / $509.61 / $567.07
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$69.83 / $98.79 / $117.21
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$65.53 / $99.60 / $214.28
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.64 / $536.29 / $1,381.31
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$60.56 / $87.83 / $214.71
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$340.21 / $459.09 / $855.05
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.38 / $792.91 / $923.32
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$76.76 / $76.76 / $76.76
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.67 / $584.38 / $921.30
Priority Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.98 / $85.30 / $132.93
Priority Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$307.43 / $494.32 / $782.08
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$66.56 / $66.56 / $79.66
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$418.88 / $426.62 / $527.20
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$64.90 / $66.56 / $79.66
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$352.32 / $360.06 / $447.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.34 / $529.29 / $884.25
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$64.62 / $79.91 / $133.47
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$366.16 / $478.70 / $761.90