| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $101.00 | $112.19 | $8,500.00 | |
Medica
| Facility | $101.00 | $137.91 | $303.00 |
Epidrm Agrft T/A/L Ea 100 Cm/Ea 1% Bdy Inft/Chld
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $101.00 | $112.19 | $8,500.00 | |
Medica
| Facility | $101.00 | $137.91 | $303.00 |