| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1.19 | $1.19 | $1.19 | |
Aetna
| Professional | $1.19 | $1.19 | $1.91 | |
Regence BlueShield
| Facility | $2.58 | $2.86 | $3.17 | |
United
| Professional | $1.13 | $2.39 | $3.15 |
Stomach Tube - Levine Type (Special Coverage Instructions Apply. See Cim: 65-10 And Mcm: 2130 4450)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1.19 | $1.19 | $1.19 | |
Aetna
| Professional | $1.19 | $1.19 | $1.91 | |
Regence BlueShield
| Facility | $2.58 | $2.86 | $3.17 | |
United
| Professional | $1.13 | $2.39 | $3.15 |