| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $20.02 | $24.55 | $37.38 |
Cigna
| Facility | 26 | $25.18 | $25.18 | $25.18 |
Medcost
| Facility | 26 | $32.00 | $34.79 | $61.16 |
Wellcare
| Facility | 26 | $100.00 | $129.00 | $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 | $20.02 | $24.55 | $37.38 |
Cigna
| Facility | 26 | $25.18 | $25.18 | $25.18 |
Medcost
| Facility | 26 | $32.00 | $34.79 | $61.16 |
Wellcare
| Facility | 26 | $100.00 | $129.00 | $129.00 |