| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $54.60 | $54.60 | $54.60 |
Health Alliance Plan
| Facility | 26 | $38.04 | $38.04 | $54.60 |
Acute Gastrointestinal Blood Loss Imaging
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $54.60 | $54.60 | $54.60 |
Health Alliance Plan
| Facility | 26 | $38.04 | $38.04 | $54.60 |