| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QZ | $269.42 | $269.42 | $269.42 |
Medica
| Facility | QK | $39.50 | $39.50 | $39.50 |
Medica
| Facility | QX | $39.50 | $39.50 | $39.50 |
Medica
| Facility | QY | $39.50 | $39.50 | $39.50 |
Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; not otherwise specified
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QZ | $269.42 | $269.42 | $269.42 |
Medica
| Facility | QK | $39.50 | $39.50 | $39.50 |
Medica
| Facility | QX | $39.50 | $39.50 | $39.50 |
Medica
| Facility | QY | $39.50 | $39.50 | $39.50 |