| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $76.92 | $146.93 | $8,500.00 | |
Medica
| Facility | $76.92 | $146.93 | $249.78 |
Fth/Gft Fr W/Dir Clsr Trnk Ea Addl 20 Sq Cm
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $76.92 | $146.93 | $8,500.00 | |
Medica
| Facility | $76.92 | $146.93 | $249.78 |