| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $340.49 | $340.49 | $349.11 | |
Health Alliance Plan
| Facility | $340.49 | $349.11 | $830.27 | |
Molina
| Professional | $30.00 | $30.00 | $100.00 |
Unlisted miscellaneous procedure, diagnostic nuclear medicine
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $340.49 | $340.49 | $349.11 | |
Health Alliance Plan
| Facility | $340.49 | $349.11 | $830.27 | |
Molina
| Professional | $30.00 | $30.00 | $100.00 |