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Indiana rates for HCPCS 78491

Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); single study, at rest or stress (exercise or pharmacologic)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,300.00 / $4,323.00 / $5,236.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,300.00 / $1,300.00 / $1,300.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$756.64 / $3,905.00 / $4,323.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$756.64 / $756.64 / $1,210.61
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.69 / $358.06 / $549.16
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.76 / $392.26 / $529.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$810.30 / $4,323.00 / $4,323.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.66 / $451.04 / $2,537.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$702.01 / $1,453.40 / $2,781.97