| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $500.20 | $500.20 | $500.20 |
Anes Nrv Musc Tdn Fsca&Brs Upr Arm/Elbow Nos
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | QX | $500.20 | $500.20 | $500.20 |