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Pennsylvania rates for HCPCS 74190

Peritoneogram (eg, after injection of air or contrast), radiological supervision and interpretation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$21.73 / $23.90 / $68.67
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$25.18 / $25.18 / $25.18
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$21.73 / $39.77 / $71.06
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$15.76 / $25.18 / $25.18
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$21.92 / $21.92 / $24.16