| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $261.62 | $6,541.00 | $13,413.92 | |
Moda Health
| Facility | $441.40 | $617.96 | $781.86 | |
Providence
| Facility | $441.40 | $617.96 | $781.86 |
Prep Site F/S/N/H/F/G/M/D Gt Addl 100 Sq Cm/1pct
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $261.62 | $6,541.00 | $13,413.92 | |
Moda Health
| Facility | $441.40 | $617.96 | $781.86 | |
Providence
| Facility | $441.40 | $617.96 | $781.86 |