| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $20.32 | $20.32 | $20.32 | |
Aetna
| Professional | $20.32 | $20.32 | $20.32 | |
Molina
| Professional | $36.00 | $60.00 | $1,500.00 |
Technetium Tc-99m sodium gluceptate, diagnostic, per study dose, up to 25 mCi
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $20.32 | $20.32 | $20.32 | |
Aetna
| Professional | $20.32 | $20.32 | $20.32 | |
Molina
| Professional | $36.00 | $60.00 | $1,500.00 |