| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $206.72 | $206.72 | $206.72 | |
Medica
| Facility | $206.72 | $219.12 | $419.64 | |
Medica
| Professional | $206.72 | $206.72 | $206.72 |
Tc99m Fanolesomab
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $206.72 | $206.72 | $206.72 | |
Medica
| Facility | $206.72 | $219.12 | $419.64 | |
Medica
| Professional | $206.72 | $206.72 | $206.72 |