| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $102.13 | $102.13 | $128.68 |
Health Alliance Plan
| Facility | 26 | $84.83 | $84.83 | $107.23 |
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 | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $102.13 | $102.13 | $128.68 |
Health Alliance Plan
| Facility | 26 | $84.83 | $84.83 | $107.23 |