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Maine rates for HCPCS 78431

Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); multiple studies at rest and stress (exercise or pharmacologic), with concurrently acquired computed tomography transmission scan

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$125.00 / $125.00 / $125.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$90.00 / $125.00 / $265.00
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$91.10 / $111.83 / $178.99
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$112.58 / $143.52 / $193.70
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$106.76 / $123.52 / $231.75
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$90.00 / $134.80 / $265.00
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$91.50 / $131.81 / $174.30