| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $30.90 | $81.28 | $123.03 |
Martin's Point
| Facility | 26 | $30.90 | $64.57 | $109.65 |
UPMC Health Plan
| Facility | 26 | $31.62 | $37.15 | $37.15 |
Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $30.90 | $81.28 | $123.03 |
Martin's Point
| Facility | 26 | $30.90 | $64.57 | $109.65 |
UPMC Health Plan
| Facility | 26 | $31.62 | $37.15 | $37.15 |