| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $699.86 | $699.86 | $699.86 |
Aetna
| Facility | QX | $576.35 | $576.35 | $1,586.20 |
Anes Iper Upr Abd Gastric Rstcv Px Mo
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QK | $699.86 | $699.86 | $699.86 |
Aetna
| Facility | QX | $576.35 | $576.35 | $1,586.20 |