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Maine 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
$2,048.00 / $5,000.00 / $5,000.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,000.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$743.65 / $1,027.21 / $1,685.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,476.94 / $1,808.58 / $3,155.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.28 / $709.16 / $960.24
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,744.60 / $2,018.50 / $3,787.18
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,980.00 / $5,000.00 / $5,000.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $5,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,178.24 / $1,807.85 / $3,270.47