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Maine rates for HCPCS 78264

Gastric Emptying Imaging Study

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$44.07 / $44.07 / $44.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.87 / $305.11 / $544.33
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.17 / $37.64 / $56.92
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$218.71 / $268.31 / $488.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.38 / $388.69 / $576.07
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.82 / $47.49 / $69.30
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$291.56 / $343.02 / $506.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.36 / $542.21 / $700.18
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.23 / $60.59 / $81.68
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$337.13 / $478.57 / $618.50
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.03 / $423.50 / $794.58
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.34 / $52.46 / $98.42
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$320.69 / $371.04 / $696.15
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$44.07 / $44.07 / $44.68
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.87 / $384.39 / $564.21
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.17 / $44.07 / $68.70
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$218.71 / $340.32 / $495.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.50 / $482.78 / $619.54
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.42 / $51.73 / $73.30
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$271.42 / $429.46 / $569.19