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Wisconsin rates for RC 0404

Other Imaging Services - Positron Emission Tomography

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,119.00 / $3,119.00 / $3,119.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,335.58 / $4,726.00 / $6,258.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,200.00 / $5,200.00 / $5,200.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,619.78 / $5,619.78 / $5,619.78
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,316.62 / $7,316.62 / $7,316.62
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,283.75 / $7,035.08 / $9,391.12