| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $40.40 | $40.40 | $40.40 |
Health Alliance Plan
| Facility | 26 | $27.12 | $27.12 | $40.40 |
Quant Differential Pulm Perfusion W/Wo Imaging
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $40.40 | $40.40 | $40.40 |
Health Alliance Plan
| Facility | 26 | $27.12 | $27.12 | $40.40 |