| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $18.79 | $18.79 | $18.79 |
Medcost
| Facility | 26 | $32.00 | $41.00 | $68.38 |
Peritoneogram Rs&I
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $18.79 | $18.79 | $18.79 |
Medcost
| Facility | 26 | $32.00 | $41.00 | $68.38 |