| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $25.68 | $29.05 | $50.76 |
Medica
| Facility | 26 | $51.77 | $51.77 | $129.00 |
Peritoneogram (eg, after injection of air or contrast), radiological supervision and interpretation
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $25.68 | $29.05 | $50.76 |
Medica
| Facility | 26 | $51.77 | $51.77 | $129.00 |