| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $204.17 | $204.17 | $204.17 | |
Aetna
| Professional | $204.17 | $204.17 | $204.17 | |
Molina
| Professional | $42.66 | $42.66 | $50.12 |
Technetium Tc-99m fanolesomab, diagnostic, per study dose, up to 25 mCi
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $204.17 | $204.17 | $204.17 | |
Aetna
| Professional | $204.17 | $204.17 | $204.17 | |
Molina
| Professional | $42.66 | $42.66 | $50.12 |