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New Hampshire 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
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,000.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,476.94 / $3,155.56 / $4,575.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,583.58 / $3,203.85 / $8,778.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$573.00 / $1,005.05 / $1,343.58
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,765.35 / $3,084.63 / $6,175.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.53 / $1,895.49 / $5,320.35
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,065.24 / $1,171.76 / $1,491.34