| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $863.94 | $863.94 | $863.94 |
Martin's Point
| Facility | QX | $863.94 | $863.94 | $863.94 |
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 |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $863.94 | $863.94 | $863.94 |
Martin's Point
| Facility | QX | $863.94 | $863.94 | $863.94 |