| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $94.78 | $94.78 | $94.78 |
Sanford Health Plan
| Professional | 26 | $120.66 | $157.16 | $179.19 |
Endoluminal imaging of coronary vessel or graft using intravascular ultrasound (IVUS) or optical coherence tomography (OCT) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; initial vessel (List separately in addition to code for primary procedure)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $94.78 | $94.78 | $94.78 |
Sanford Health Plan
| Professional | 26 | $120.66 | $157.16 | $179.19 |