| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $100.00 | $100.00 | $100.00 |
Positron emission tomography radiopharmaceutical, diagnostic, for nontumor identification, not otherwise classified
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $100.00 | $100.00 | $100.00 |