| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $251.19 | $346.74 | $389.05 |
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 | $251.19 | $346.74 | $389.05 |