| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $27.47 | $27.47 | $27.47 |
Cigna
| Facility | 26 | $26.26 | $26.26 | $26.26 |
Health Alliance Plan
| Facility | 26 | $19.13 | $19.13 | $27.47 |
Urography, infusion, drip technique and/or bolus technique; with nephrotomography
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $27.47 | $27.47 | $27.47 |
Cigna
| Facility | 26 | $26.26 | $26.26 | $26.26 |
Health Alliance Plan
| Facility | 26 | $19.13 | $19.13 | $27.47 |