| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $3,000.00 | $3,000.00 | $3,000.00 | |
Providence
| Facility | $3,000.00 | $3,000.00 | $3,000.00 |
Quan Us Tiss Charac I&R W/O Dx Us Same Anat
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $3,000.00 | $3,000.00 | $3,000.00 | |
Providence
| Facility | $3,000.00 | $3,000.00 | $3,000.00 |