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Maine rates for HCPCS 95921

Testing of autonomic nervous system function; cardiovagal innervation (parasympathetic function), including 2 or more of the following: heart rate response to deep breathing with recorded R-R interval, Valsalva ratio, and 30:15 ratio

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$46.77 / $46.77 / $46.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $89.13 / $125.89
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.02 / $46.77 / $117.49
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$36.31 / $42.66 / $64.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $95.50 / $165.96
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.88 / $48.98 / $83.18
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$28.84 / $47.86 / $83.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $125.89 / $194.98
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.12 / $61.66 / $102.33
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$15.85 / $60.26 / $97.72
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $128.82 / $257.04
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.77 / $66.07 / $125.89
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$48.98 / $67.61 / $144.54
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $95.50 / $229.09
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$40.74 / $51.29 / $134.90
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$34.67 / $45.71 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $123.03 / $199.53
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.71 / $64.57 / $97.72
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$33.88 / $57.54 / $102.33