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Pennsylvania 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
$125.00 / $151.34 / $400.00
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$117.01 / $117.01 / $117.01
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$125.00 / $178.75 / $408.75
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$117.01 / $117.01 / $117.01
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$100.23 / $100.23 / $119.19