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Pennsylvania rates for RC 0404

Other Imaging Services - Positron Emission Tomography

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,738.00 / $3,738.00 / $3,738.00
Ambetter
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,158.30 / $2,525.73 / $4,754.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$874.00 / $2,815.68 / $4,003.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,738.00 / $3,738.00 / $3,738.00
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,254.48 / $2,318.23 / $3,000.98
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$874.00 / $2,611.00 / $3,336.00