| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $115.85 | $115.85 | $177.43 |
Kaiser Permanente
| Professional | 26 | $115.86 | $163.79 | $186.45 |
Pacific Source
| Facility | 26 | $108.04 | $141.13 | $149.41 |
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; each additional vessel (List separately in addition to code for primary procedure)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $115.85 | $115.85 | $177.43 |
Kaiser Permanente
| Professional | 26 | $115.86 | $163.79 | $186.45 |
Pacific Source
| Facility | 26 | $108.04 | $141.13 | $149.41 |