| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | QK | $39.50 | $39.50 | $52.00 |
Medica
| Facility | QX | $39.50 | $39.50 | $52.00 |
Medica
| Facility | QY | $39.50 | $39.50 | $52.00 |
Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; renal procedures, including upper one-third of ureter, or donor nephrectomy
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | QK | $39.50 | $39.50 | $52.00 |
Medica
| Facility | QX | $39.50 | $39.50 | $52.00 |
Medica
| Facility | QY | $39.50 | $39.50 | $52.00 |