| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $100.00 | $100.00 | $215.62 |
Cigna
| Facility | 26 | $268.52 | $305.14 | $481.38 |
Quartz
| Facility | 26 | $460.18 | $460.18 | $460.18 |
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 | $100.00 | $100.00 | $215.62 |
Cigna
| Facility | 26 | $268.52 | $305.14 | $481.38 |
Quartz
| Facility | 26 | $460.18 | $460.18 | $460.18 |