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North Carolina rates for HCPCS 78433

Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), dual radiotracer (eg, myocardial viability); with concurrently acquired computed tomography transmission scan

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$102.64 / $102.64 / $242.65
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$117.01 / $117.01 / $117.01
Medcost
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$159.75 / $246.41 / $317.18
Wellcare
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$244.48 / $244.48 / $499.51