| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $20.89 | $41.69 | $70.79 |
Hally Health
| Professional | 26 | $27.54 | $44.67 | $102.33 |
Hally Health
| Facility | 26 | $100.00 | $100.00 | $100.00 |
Urography, infusion, drip technique and/or bolus technique; with nephrotomography
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $20.89 | $41.69 | $70.79 |
Hally Health
| Professional | 26 | $27.54 | $44.67 | $102.33 |
Hally Health
| Facility | 26 | $100.00 | $100.00 | $100.00 |