| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $250.97 | $336.67 | $392.92 |
Radex Gi Upr W/Wo Glucose W/Sm Intest Follw-Thru
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $250.97 | $336.67 | $392.92 |