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Maine rates for HCPCS 78815

Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; skull base to mid-thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$125.89 / $125.89 / $125.89
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.00 / $147.91 / $380.19
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$109.65 / $151.36 / $234.42
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$87.10 / $151.36 / $251.19
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$134.90 / $158.49 / $309.03
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$112.20 / $162.18 / $302.00
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$134.90 / $169.82 / $239.88