| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $90.05 | $120.37 | $8,500.00 | |
Medica
| Facility | $90.05 | $122.07 | $270.14 |
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 | $90.05 | $120.37 | $8,500.00 | |
Medica
| Facility | $90.05 | $122.07 | $270.14 |