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Nebraska 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
$97.98 / $98.26 / $98.26
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$571.32 / $571.32 / $571.32
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$460.18 / $460.18 / $460.18
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$306.12 / $315.02 / $571.32