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South Dakota 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
$103.86 / $103.86 / $103.86
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$130.63 / $172.49 / $196.66