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Washington 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
$76.29 / $122.06 / $220.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.18 / $604.62 / $1,016.79
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$64.28 / $76.29 / $165.93
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$369.97 / $528.33 / $867.97
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$797.67 / $797.67 / $797.67
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$36.72 / $107.20 / $128.41
Asuris Northwest Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$90.49 / $140.27 / $2,533.52
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$633.40 / $1,048.49 / $2,964.79
Asuris Northwest Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$92.40 / $157.54 / $546.15
Asuris Northwest Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$541.00 / $901.63 / $3,229.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$633.52 / $1,025.05 / $1,527.87
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$90.84 / $139.83 / $220.67
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$542.67 / $885.22 / $1,310.15
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$86.57 / $167.91 / $6,255.42
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.64 / $1,168.80 / $1,486.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$86.57 / $162.21 / $200.62
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$516.07 / $972.19 / $1,260.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.77 / $497.95 / $982.20
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$108.90 / $131.71 / $136.68
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$712.20 / $712.20 / $712.20
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$87.12 / $108.90 / $132.66
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$591.74 / $709.68 / $741.69
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$90.49 / $90.49 / $90.60
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$687.84 / $1,018.85 / $1,242.35
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$102.74 / $152.18 / $185.59
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$585.10 / $866.67 / $1,053.85
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$2,533.52 / $2,533.52 / $4,287.53
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$633.40 / $903.06 / $1,273.78
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$92.40 / $137.02 / $185.80
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$541.00 / $782.58 / $1,096.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.34 / $507.78 / $1,226.61
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$62.54 / $76.91 / $189.99
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$369.03 / $455.87 / $1,082.06