PET
What goes into a price?
Negotiated prices across insurers
Self pay or cash prices vary by facility when paying out of pocket without insurance benefits. The chart shows you how the lowest and highest amounts facilities charge for this service if you were paying without insurance benefits. If you're uninsured or not submitting a claim to insurance, you also have the right to a Good Faith Estimate under federal law. Contact the provider for a copy of your Good Faith Estimate or to better understand payment options available to you.
Procedures included in this package
This list includes the services and fees bundled into the PET Standard Service Package (SSP RA013). The final price for the procedure will depend on which services your provider ultimately performs, your insurance plan and your medical benefits.
| Code | Code Type | Description |
|---|---|---|
| HCPCS A9596 | Facility Fee | Gallium Ga-68 gozetotide, diagnostic, (Illuccix), 1 millicurie |
| HCPCS 78815 | Facility Fee | Positron emission tomography-CT scan from skull to mid-thigh |
| Revenue Code 250 | Facility Fee | Pharmacy (Also see 063X, an extension of 250X) - General |
| HCPCS 64483 | Professional Fee | Injecting Anesthetic/Steroid into Spine, with Imaging Guidance, Single Level |