| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $85.71 | $85.72 | $109.61 |
Martin's Point
| Facility | 26 | $85.71 | $105.17 | $254.58 |
UPMC Health Plan
| Facility | 26 | $72.59 | $72.59 | $72.59 |
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 | $85.71 | $85.72 | $109.61 |
Martin's Point
| Facility | 26 | $85.71 | $105.17 | $254.58 |
UPMC Health Plan
| Facility | 26 | $72.59 | $72.59 | $72.59 |